I’m Still Treating Patients… but Medicare Stopped Paying Me! Congress Still Gets Paid, so why can’t Therapists?

Trapped by the System: When Therapists Can’t Afford to Treat the People Who Need Us Most

For most occupational therapists, our hearts are in the right place. We want to help people regain independence, stay safe at home, and live with dignity. But lately, it’s been hard to ignore a painful truth, the system we work in doesn’t value that mission.

About 80% of my caseload is Medicare. These are the people I want to serve: older adults recovering from falls, surgeries, or illnesses; clients trying to stay in their homes and out of nursing facilities; individuals managing Parkinson’s or arthritis who just need some help maintaining their function and confidence.

They are the backbone of our communities. But right now, therapists like me are stuck in an impossible situation.

The Medicare Payment Freeze

As of October 1, 2025, Medicare claims under the Physician Fee Schedule, which includes occupational therapy, are being held until Congress acts on expired payment provisions.
That means that even though I’m still seeing patients every day, documenting, and submitting claims… I’m not getting paid.

Now here’s the kicker: I can’t just “opt out.” Occupational therapists aren’t allowed to.
If I want to keep treating my seniors, I have no choice but to stay enrolled and keep working while payments are delayed indefinitely.

Even if we could opt out, most people wouldn’t understand what that means. For many seniors and families, insurance feels like a safety blanket. Something they’ve paid into their whole lives and can rely on when they need care. The thought of paying privately can feel overwhelming or “too expensive.”

But here’s what most people don’t realize: private pay doesn’t automatically mean unaffordable. Many independent providers, clinics, and even physicians offer discounted rates for private pay. And little old small-business me? I offer it too.

I know my patients. I care about their needs, and if skipping the insurance red tape helps them get the care they deserve, I’m willing to work with them.

The problem is, the system has convinced people that care without insurance isn’t possible when in reality, it might actually be simpler, faster, and in some cases, less expensive.

Imagine running a business where 80-90% of your income is frozen, and quitting isn’t an option. That’s what this feels like.

I’m Not a Corporation…. I’m It!!!

I’m not backed by a hospital or a large healthcare network.
It’s just me.

I’m a small business owner, a solo practitioner, and the person who wears every hat!! I am a therapist, scheduler, biller, marketing manager, and bookkeeper. When Medicare doesn’t pay, there’s no corporate cushion to absorb the hit.

I still have to cover business expenses, insurance, software, taxes, and gas to get to my patients’ homes. I still have to pay the bills that keep DRM Wellness running, and when payments stop, that burden lands directly on me.

I chose to open a private practice because I believe personalized, judgment-free therapy can change lives. But right now, the system is punishing small, patient-centered providers for caring too much and daring to go independent.

We Can’t Opt Out…. Literally!

Most people don’t realize that occupational therapists can’t legally opt out of Medicare.
Physicians, psychologists, and some other provider types can. But OTs and PTs are required to remain in the system, even when it’s financially unsustainable.

That means:

• We can’t enter private contracts with Medicare beneficiaries.

• We can’t legally say, “I’ll just charge you privately.”

• We can’t walk away from a system that’s refusing to pay.

• And get this...I can’t even offer something as simple as a free balance check at a community wellness fair without risking penalties.
  If a Medicare patient were to participate, it could be seen as an “inducement” or “kickback” under federal regulations.

So even when I try to give back to the community, educate seniors, or help prevent falls, I have to stop and think, “Could this get me in trouble?”

That’s how broken the system has become. Therapists are punished for trying to help.

So we wait….and while we wait, our businesses take the hit.

The Impact on Seniors

This isn’t just about therapists, it’s about access.
When small practices close their doors, people lose access to care.
When therapists burn out or leave the field, older adults are left with fewer options.

If the system keeps treating therapy as an afterthought, we’ll see more falls, more hospitalizations, and more people forced into nursing homes. Not because they wanted to be there, but because no one could afford to help them stay home safely.

It’s Time to Fix the System

Therapists deserve to be paid fairly for the work we do. Seniors deserve consistent access to care. And no healthcare provider should be required to participate in a system that doesn’t pay them.

Until something changes, I’ll keep doing what I’ve always done…showing up, caring deeply, and advocating for my patients.

But the hard truth is, caring doesn’t pay the bills.

Just like everyone else, I still have a mortgage to pay, insurance premiums to cover, food to buy, school fees for my kids, and lights to keep on at home. When Medicare payments are delayed or reduced, it doesn’t just affect my business… it affects my family, too.

Meanwhile, our elected representatives, the same people whose inaction causes these payment freezes, continue to receive their paychecks and health insurance without interruption.
They aren’t waiting months for reimbursement. They aren’t juggling unpaid claims or wondering how to make payroll.

Yet small healthcare providers like me are expected to quietly shoulder the fallout, absorbing every delay and every cut while still delivering the same quality of care.

I’m not a big corporation that can sustain months of nonpayment. I’m one person running a small business, trying to make a difference for people who deserve better.

It’s time for CMS and Congress to stop holding the hands that heal. To remember that behind every “payment freeze” and “policy delay” are real people, real families, and real patients who can’t afford to wait.
If something doesn’t change soon, more small practices like mine will be forced to walk away and the ones who will suffer most are the seniors who depend on us.

If you or someone you love needs help developing skills, restoring function, or maintaining independence, call DRM Wellness. We’re still out here doing the work… showing up, caring deeply, and making a difference for the people who need us most.

But we can’t fix this alone.

Call your state, local, and national representatives and tell them this system is broken. Tell them that the therapists helping our seniors deserve to be paid. Tell them that small practices like mine matter, because without us, countless seniors lose access to the care that keeps them safe and independent.

It’s time for action. It’s time for change….and it starts with making our voices heard.

📞 Call us at (402) 940-8181
📧 Email us at [email protected]
💻 Learn more at www.DRMwellness.org

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