Sally moved to the short-term rehab wing of a skilled nursing facility after she got out of the hospital for treatment of a badly broken leg. She reported, "My doctor had told me clearly to stay off that leg. But they kept taking me to PT. They kept making me try to walk and do exercises. Finally, I said to them, 'You need to make an appointment with my orthopedic surgeon and take me to his office for an evaluation, because this isn't working. You can't keep trying to force me to do something that he's told me he doesn't want me to do."

The facility agreed. In that office visit, Sally said, "The doctor wrote the orders very strictly: No weight-bearing exercises. So after that they still took me every day to PT (physical therapy), but they did exercises that were prescribed for a non-weight-bearing injury."

Right after she was discharged from the skilled nursing facility, Sally had physical therapy in her own home, provided by a home healthcare agency. After those services ended, she explained, "I went to Peterson's (Peterson 2 Physical Therapy) on Iron Springs Road. They have an in-water treadmill. I was trying to get my gait back, and in the water, I could walk for 30-40 minutes."

She continued, "Peterson's is wonderful. They know their business and were quite helpful in getting me back to a functioning person."

When Medicare would no longer cover the sessions, Sally took advantage of one of the other options Peterson's offers. Brek Peterson, one of the owners, explained choices that patients have when their insurance will no longer pay for treatment.

"If people want the same attention from a physical therapist that they were getting before, they can continue therapy and pay for it themselves. If they can function independently, they can sign up for our Wellness Clinic, which is similar to a gym membership. In that case, they don't need an appointment and can come and go as they please, using the same equipment that they used when they were physical therapy patients."

While the costs vary depending on services used, sessions fully supported by a physical therapist may cost about $60-70 per session when paid for outside of insurance. The Wellness Clinic costs about $60-70 per month.

Wendie A. Howland, an east coast-based certified nurse life care planner, rehabilitation nurse and case manager (www.howlandhealthconsulting.com), noted that home health agencies are also typically willing to continue to provide in-home physical therapy after insurance coverage runs out if the patient is willing and able to pay for the services directly.

Alternatively, Howland said, "If the patient has met all goals, it may be possible to set higher ones to justify continued services. If not, or if the patient consistently fails to meet goals, then the therapist can give her very thorough instructions (and equipment, e.g., Theraband exercise bands or putty) for a continuing self-managed home exercise program, and the physician can prescribe periodic follow-ups to see that it is being done properly. Many people think that the only therapy that is any good are the sessions that are provided by a therapist or therapy aide; this is not true, as much benefit can be derived from a solid home exercise program performed by the patient at home."

Howland also added that another option for some people after they finish with physical therapy is to sign up for sessions with a personal trainer at a YMCA. She noted, "Almost all (YMCAs) have personal trainers who are very experienced in cases like this, and can schedule sessions for such patients in the heated pool there."

Supporting this general view, Trisha Soriano, aquatics director at the Prescott YMCA, commented that a number of the personal trainers there are also trained lifeguards and would be able to conduct a pool-based personal training program on request.

In summary, make sure that treatment goals and approaches make sense to you. Before you agree to be discharged, make sure that your doctor agrees and that you know your options for further care once insurance-paid therapy ends.

With careful attention, the chances are good that you can get therapy that will help you.