Erin Huppert, who was adopted from South Korea as an infant, wasn’t much interested in learning more about her pre-adoption history. But the St. Paul resident is reconsidering that now.

“I have never had any interest in finding anything out about my biological family or trying to contact them in any way,” Huppert said. “I had always held the opinion that they made the decisions they needed to make at the time, and that my family was my American adopted family. And it really only has been in light of the stories over the last couple of months that I’m now reevaluating everything.”

Those stories are from an Associated Press investigation released last year looking into fraudulent adoption practices that facilitated the adoption of thousands of Korean children into families around the world in the years following the Korean War.

After a nearly three-year investigation, a South Korean commission in late March found that the government bears responsibility for facilitating a program with widespread fraud and abuse — enabled by private agencies — that violated children’s human rights.

It’s a landmark acknowledgment of something long suspected among Korean adoptees, experts say.

Prior to the commission sharing its findings, Huppert said that while she has at times wondered if what she’s known about her background prior to her adoption is true or to what degree, her confidence in that information has substantially dropped.

“And both I and my adoptive parents have all agreed that I should probably reevaluate and reconsider my interest in reaching out, if for no other reason than the idea that there are two people over in South Korea who maybe have been looking for their child this entire time. It’s absolutely heart-wrenching,” Huppert said.

Erin Huppert, who was adopted from South Korea in the early 1980s, looks through her adoption paperwork at her St. Paul home on Friday, March 14, 2025. (John Autey / Pioneer Press)

200,000 adoptees

Since the 1950s, an estimated 13,000 to 15,000 children have been adopted from South Korea by American parents in Minnesota, according to MNopedia, a website run by the Minnesota Historical Society.

It’s just a fraction of the more than 200,000 Korean adoptees around the world — mostly adopted in the 1970s and ‘80s. But it makes Minnesota the state with the highest concentration of Korean adoptees in the U.S.

Several organizations have facilitated those adoptions in the state, including St. Paul-based Children’s Home Society – which began adoptions from South Korea in the late 1960s – and Lutheran Social Service of Minnesota.

The two organizations formed a partnership and combined adoption services in 2012 and announced earlier this month that they will merge.

On Thursday, they released a statement on the commission’s findings and shared resources available to adoptees both with and outside of CHS/LSS.

“Here at Children’s Home and LSS, we understand the history, complexity and emotions associated with this report by the South Korean government and want to acknowledge the weight and impact of these findings on adoptees, birth families, adoptive families, and their loved ones,” the statement said.

It added: “The best interest of each child is at the center of our work. We want adoptees and families to know that we are here for them and want to be a place of support, resources, and consultation.”

In July, the Korean government is expected to begin overseeing adoption and post-adoption services directly, previously a responsibility of Korean agencies, according to CHS/LSS.

“The oversight of South Korean adoption records is moving from the Korean adoption agencies to the National Center for the Rights of the Child (NCRC). To conduct a search that includes your South Korean adoption record, you will need to petition the NCRC for these services directly. At this time, we do not know how long it will take to access South Korean search services,” CHS/LSS stated Thursday.

Truth and Reconciliation Commission Chairperson Park Sun Young, right, comforts adoptee Yooree Kim during a press conference in Seoul, South Korea, Wednesday, March 26, 2025. (AP Photo/Ahn Young-joon)

The investigation

The adoption industry grew out of the aftermath of the Korean War in the 1950s, when Americans adopted biracial children born to Korean women and Western soldiers. As the country made its way out of poverty, South Korea continued to rely on private adoption agencies to bring millions of dollars into the country, and saved even more by not developing its own child welfare program.

South Korea’s then-military governments saw several benefits to international adoption, allowing the country to reduce the number of children to care for, erase the “social problem” of unwed mothers and strengthen its relationships with Western countries.

Agencies registered most adoptees as abandoned orphans found in the streets, making their origins difficult or impossible to track down when many actually had identifiable relatives.

In dozens of the cases examined by the AP, which worked with PBS’s “Frontline” to produce a documentary on the findings, children were kidnapped off the streets and sent abroad and many parents claimed they were told their newborns were dead or too sick to survive.

Minnesota history

Children’s Home Society began doing adoptions with South Korea in the late 1960s, according to Kristina Berg, CHS senior director of adoption and foster care services, and adoption programs with South Korea formally began in 1967 for CHS and in 1969 for Lutheran Social Service.

Since 1970, there have been 8,282 adoptions from South Korea through Children’s Home, according to Berg. Of those adoptions, 4,137 occurred between 1970 and 1988.

“I think it’s a difficult piece because a lot of us here currently were not practicing at the time, but we are doing an internal audit of our records and our practice at the time,” Berg said in an interview with the Pioneer Press in late January.

“We’ve certainly seen an increase in requests for post-adoption service support, and have had conversations with adoptees and adoptive parents, both, discussing the AP and the investigation and additional articles, discussing their individual circumstances, providing both agency and non-agency resources,” Berg said.

As an adoption service provider, Children’s Home trusts the governing authorities of each country to ensure guidelines are met and makes efforts to partner with ethical organizations and countries, Berg said in a later email. The organization also makes sure to follow up when concerns are heard and to adjust practices or close programs when needed, she added.

The agency began to offer post-adoption services with South Korea in the 1970s, according to Berg.

“And we have a lot of, now, adoptees and those with lived experience on our team,” Berg said. “I believe about 75% of our team has a close personal connection to adoption, and that’s including our staff, leadership, board members. It includes Korean and other domestic and international adoptees.”

The AP and “Frontline” investigation underscores the importance of the Hague Convention on the Protection of Children, which the United States implemented in 2008 and South Korea is set to do in 2025, according to Berg. The Hague Adoption Convention is an international treaty meant to safeguard children and families in intercountry adoptions.

Doubt, questions

According to Huppert’s adoption records, her biological parents were young and unmarried with families who did not support their relationship when she was put up for adoption.

“I think, in light of the reporting from the Associated Press and the subsequent reports, it’s pretty, well, it is clear to me that I should question how true some of those details are, because it looks very similar to the same narratives that have been produced at a very high volume from those agencies,” Huppert said.

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The findings have made adoptee Anna Lund, who grew up in Minneapolis, question parts of her background as well. As a teenager, Lund visited South Korea with her mother and sister and met the woman who fostered her before her adoption.

“I mean, after that reporting came out, I even started to question, like, ‘Was that really my foster mother? Or was this just some lady that they brought in?’” Lund said.

Concerns of fraud are not new. But perceptions of how adoptees should feel about their adoption can be a barrier to those concerns, said Kim Park Nelson, an associate professor of ethnic studies at Winona State University whose research specializes in transnational adult adoptees in the United States.

Because many people see adoption as an overall good, with a focus on a birth mother giving her baby a better life and adoptive parents doing something selfless, the adopted child is kind of forgotten, Lund said.

“And they’re almost seen as like a blank slate, and now they can go and they can live with this family and everything’s great for them. And I think that what they’ve lost is not really considered as much,” Lund said.

Adoption inherently involves loss, something that adoptees and their families need to navigate, said Richard Lee, a University of Minnesota psychology professor who studies international adoption.

In the last several decades, many adoptees have developed adoptee-focused organizations that can also help other adoptees process their response to the findings, Lee said.

“And they’ve been pushing hard on these issues. So for them, this investigation is something that they’ve been asking for for decades, and it’s a validation of their efforts that they’ve put in, in the face of so much opposition from adoption agencies, governments and many adoptive families,” Lee said.

Emotional touchstones

Adoptees can go through a mix of emotions upon finding out the information they’ve been told about their background may be false, experts say.

Researcher JaeRan Kim is working on an adoptee consciousness model that looks at the different “touchstones” adoptees might experience in adulthood related to their adoption. Kim is a faculty member at the University of Washington Tacoma and researcher who focuses on post-adoption well-being, particularly among adult adoptees, and grew up in Minnesota.

One touchstone is called rupture, which can include when an adoptee finds out something isn’t the way they thought it was, Kim said.

Adoptees also can experience dissonance, Kim said.

“And dissonance is that real internal struggle: What am I supposed to believe now? Who can I trust? How do I manage all these different feelings that I have? And for some adoptees, they shut down, and it’s too overwhelming and too much, and so then they just want to be like, ‘I don’t want to think about it anymore, I’m just going to pretend I don’t know,’” Kim said.

Other adoptees might decide to look more into their background and its context. Some go into activism or research. Others become opposed to adoption and become adoption abolitionists, Kim said.

Because the narrative around adoption is often that it was in the best interest of the child, some adoptees may find it hard to find the right support for themselves or to know that their feelings around their adoption are valid, especially when reconciling what was supposed to be a good thing for them with serious ethical issues, Kim said.

Even formal mental health support can be inadequate if the provider is not equipped to properly work with adoptees, Kim said. Resources developed by other adoptees, such as support groups or mutual aid, can be a good way for adoptees to find some support, Kim said.

“And I think that there’s been a lot of talk around adoption-competent mental health, and I think we’re still trying to figure out what that is, because so much of that has been focused on helping adoptive families with younger children who might be struggling, but there hasn’t been as much focus on their therapists and mental health clinicians really being able to address adult adoptees who are finding out these issues around their own adoption,” Kim said.

Next steps

South Korea’s Truth and Reconciliation Commission in late March recommended that the government issue an official apology over the identified problems and address grievances, as well as investigate citizenship gaps among adoptees sent to the United States and work to assist those without citizenship, who may number in the thousands, the Associated Press reported.

When it comes to what Huppert would like to hear from agencies like Children’s Home Society, it would be an apology and accountability.

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“I know that there are at least some instances where they genuinely did not know that this was happening, that they were acting in good faith,” Huppert said. “But I do have to wonder at what point, if ever, they thought about the volume of children coming through this process over the course of 15 years, and didn’t once wonder whether there was anything nefarious going on.”

Reforms in South Korea, such as a 2011 law requiring foreign adoptions to go through family courts, have led to significant declines in the country’s intercountry adoptions. Only 79 South Korean children were adopted abroad in 2023, the AP reported.

Adoption is more complex than it has often historically been portrayed, making its impacts complex as well. It’s life experience, so it’s complicated, Park Nelson said.

“And I think that the stories that have come out and the research that’s just come out about those experiences really provide some solid evidence for people to understand the adoption process differently and to understand it not just as this wonderful way that people without children can have children and do this, like, basically charity work to save children who are in bad situations, but that we’re real people, and we have real lives,” Park Nelson said.

By KIM COOK for Associated Press

Our homes have been multitasking for a while now. They may be where we work, they are certainly where we play, and in today’s stress-filled world, they’re often the place where we feel most at peace.

Spurred by the pandemic, dens became offices, extra bedrooms became workout zones, dining rooms morphed into multifunctional creative spaces.

Often, we’re seeing rooms transformed into sanctuaries of self-care: welcome to the “wellness room.”

“Small sophisticated home gyms, music rooms, meditation rooms and Zen gardens are some of the wellness spaces we’ve designed recently,” says designer Gonzalo Bueno, who owns the firm Ten Plus Three in Dallas. “Spaces for wellness, retreat and recharging are all really popular right now.”

Bueno and his team combined several of these ideas in a home renovation in Austin, Texas. There is an outdoor Zen garden, flanked indoors by a meditation room on one side and the soaking tub of the primary bath on the other, with both facing a serene green space.

Holistic high and low tech

“Soundbathing,” where you immerse yourself in soothing instrumental and natural sounds, has become popular at many professional spas. Now, companies are making versions for the home, or you can set one up yourself.

Create a low-tech soundbathing studio with some comfy pillows, yoga mats, essential oil scent and dimmed lights or candles and then either play or use recorded sounds of chimes, singing bowls and gongs. You can find links to meditation sounds online.

This photo provided by Ten Plus Three, shows a meditation room created during a home renovation in Austin. (Ten Plus Three via AP)

There are full-size beds available that use low frequency sound and vibrations, or you can find cushion-y mats with some of the same features, far less costly.

Traditional saunas use steam, but infrared light saunas are an easier-to-install alternative for indoors. Several makers offer single, two-or three-person versions made of wood or just an insulated fabric. Fancy ones come equipped with Bluetooth audio and color-changing lights.

If you really want to splash out on an in-house, multi-sensory, luxury experience, there are shower units integrating tech into customizable water, steam, lighting and music.

This photo provided by Thermasol, shows a Total Wellness Package Steam Shower. (Thermasol via AP)

Quiet and maybe deep

Jack Ovadia, whose eponymous design firm is based in New York, created a one-person onsen, the Japanese deep-soak-style tub, for a Phoenix client. The cocoon-like space has a contemplative wall of terrazzo pebbles and a pretty, petal-bedecked chandelier above.

This photo provided by Ovadia Design Group, shows a primary bath with an Onsen tub in Phoenix. (Ovadia Design Group via AP)

But he also is doing wellness rooms that can multi-serve with a sauna and then an invigorating cold plunge tub. In his own home, he has an area to practice yoga and Pilates.

“Having a private space is essential,” Ovadia says. “A wellness room should be a space where the outside world dissolves; no background noise, no movement beyond your own. This is where you go to let go; to drop into something quieter, something deeper.”

Celebrating creativity solo or with your peeps

Your ideal wellness room might be a little more energetic than the serene, spa-like versions.

“We’re designing more music rooms,” Bueno says, “which isn’t surprising since music is so healing. “

He notes how much fun it is to work with clients who have a passion — “art, yoga, music or entertaining” — and design spaces to help bring that passion home.

“Recent clients had an extensive vinyl collection,” he says. “Others have wanted a room to enjoy music during large family gatherings.”

Materials and accessories to set the mood

Make sure the size of the space suits your activity and you use materials to set the tone.

“Bring in warmth and a sense of calm with things like natural tan oak, cork, bamboo, neutral tones and organic textures,” Ovadia says.

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Small table lights can be set on a timer to play calming nature sounds. Some offer a soft amber glow or an array of soothing day-to-evening hues. Invest in a comfy sectional if you have space, or look for flop-worthy giant beanbags and squooshy oversize chairs.

If it’s an energy-filled space you’re after, Bueno has some suggestions for lighting that kicks things up a little, or a lot.

“We did a home gym with red accents, to bring in passion and motivating energy,” he says.

Engaging art can add to that vibe. Bueno mounted a clubby neon work in a large music/family room that says, “This Must Be the Place.” In the red gym hangs a contemporary piece that reads, “Keep On Keeping On.”

And for the quiet well room? Dreamy nature photographs, prints or mural wallpaper would be the chef’s kiss.

If you don’t have room for a wellness room

Nowhere to stake out a wellness room in your own place? You might have something similar in your hometown.

Public wellness spaces are becoming places to jive and gather as well. So-called social spas offering traditional spa services, as well as group hangout spaces and social activities, are popping up around the U.S.

“It’s the new nightclub,” Ovadia says. “Self-care is evolving into a shared experience, becoming a prominent scene rather than just a side routine.”

New York-based writer Kim Cook covers design and decor topics regularly for The Associated Press. Follow her on Instagram at @kimcookhome.

By TRACEE M. HERBAUGH, Associated Press

To raise adventurous, self-sufficient and health-conscious eaters, get kids in the kitchen.

It may sound too simple, but those are just a few of the benefits when kids learn to cook. Cooking builds life skills, promotes healthy eating, boosts confidence and strengthens family bonds — all while making mealtime fun.

“It helps to think of it as less of a chore and more of an opportunity to be together as a family,” said Jessica Battilana, staff editor at King Arthur Baking Company, which offers adult and children’s cooking classes.

Danielle McWilliams cooks with her daughters Reese, 7, right, and Remi, 4, at their New Jersey home on Oct. 27, 2021. (Danielle McWilliams via AP)

The food doesn’t need to be fancy, and it doesn’t all have to be homemade.

“The investment parents make early on to encourage their kids to participate in mealtime will pay dividends later, when they’re able to handle kitchen tasks independently,” Battilana said.

Whether your child loves to cook or has never held a knife, it’s not too late to start building these skills.

Some of the rewards:

A sense of accomplishment

If the COVID pandemic taught us anything, it was the importance of knowing how to cook.

During the lockdown, Becca Cooper Leebove, a mom of two in the Denver area, began teaching her children how to do simple tasks in the kitchen. Just 3 and 8 at the time, they began by dumping ingredients into a stand mixer, rolling out dough, or icing a cake.

This undated photo provided by King Arthur Baking Co. shows a pan of gingerbread rolls. (Rick Holbrook/King Arthur Baking Co. via AP)

Five years later, their skills continue to grow.

“My ultimate goal has always been family time — something to do together that’s engaging, but also important to get them off their phones or iPads,” Leebove said.

“They also love to brag when it’s done and we all eat their masterpiece together,” Leebove said.

They clean up after cooking and know how to set the table. Now that Leebove’s son is 13, he helps chop veggies and sauté meat.

Confidence and real-world skills (like math)

“It can feel special to kids to be included in an adult activity,” said Cristi Donoso, 38, from Alexandria, Virginia. Donoso is a speech therapist and encourages her clients to cook with their kids in age-appropriate ways. She’s also the mother to a 5-year-old, who has been baking with her since toddlerhood.

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“There’s a lot of real-world learning involved,” Donoso said: math concepts, language skills and self-control. Kids learn by reading and following a step-by-step recipe. It takes concentration and other executive functioning skills. They also learn how to be safe in a kitchen, requiring self-control.

Exposure and sensory experience with food help kids become well-rounded eaters, she said.

“Your food experience isn’t just about sitting down to eat. It’s about making a list, going to the store, and feeling the fruit,” she said.

An adventurous palate

Eric Brown, along with his wife, Elizabeth Brown, opened Third Space Kitchen in August 2023. At their two Massachusetts locations, they offer cooking classes for kids, often through day camps, birthday parties or as a school-break activity.

“One thing I see a lot is that they’re willing to experiment,” Brown said, and knowing what’s in the food helps kids get over any squeamishness. Or perhaps the common aversion to veggies.

Danielle McWilliams’ daughters Reese, 7, right, and Remi, 4, cook at their New Jersey home on on Oct. 27, 2021. (Danielle McWilliams via AP)

Younger kids might start by making pizza dough from scratch or decorating cupcakes. Older kids have participated in full-cake icing competitions.

“As the programs progress, I hear less of ‘Eww, I won’t touch that’ and more of ‘What is that? I’ll try it,’” said Brown, who has four kids of his own.

Paving the way for healthy eating

Childhood obesity rates have been rising for decades, and studies have show a positive correlation between healthy eating and home cooking, which can be a good alternative to ultraprocessed foods.

Jennifer Schittino, a Maryland-based working mom of two young children, wants to help them shape healthier habits for the future.

“It’s both healthier and cheaper to cook from scratch.” she said. She also wants her children to “understand the fundamentals so they can make healthy and nutritious meals on a limited budget.”

Her kids know how to use knives and rolling pins, as well as hand-crank pasta, separate an egg, cut an avocado and toss pizza.

Parents might learn about cooking too

Even if you’re not a skilled home cook, don’t be intimidated teaching kids to be one.

Start simple. Make a list of 10 things that kids can learn to master, Battilana suggested. It might include scrambled eggs, a quesadilla with guacamole, or pasta with steamed veggies.

“Practice making those 10 things often so you get good at them, can shop for them easily, and make them without a recipe,” she said. (King Arthur has a kids’ baking cookbook due out in September, “Sweet and Salty!”)

Cooking and shopping for fresh foods become a lot less intimidating the more you do it.

“I think kids are far more capable in the kitchen than we give them credit for,” Battilana said. “They may be slower, messier, but they’re capable of a lot, and usually pretty eager to try new foods — especially if they’ve had a hand in making them.” ___

Tracee M. Herbaugh writes frequently about Lifestyles topics for The Associated Press. She can be reached at www.linkedin.com/in/traceeherbaugh/.

By Jordan Rau, KFF Health News

Mari Villar was slammed by a car that jumped the curb, breaking her legs and collapsing a lung. Amy Paulo was in pain from a femur surgery that wasn’t healing properly. Katie Kriegshauser suffered organ failure during pregnancy, weakening her so much that she couldn’t lift her baby daughter.

All went to physical therapy, but their health insurers stopped paying before any could walk without assistance. Paulo spent nearly $1,500 out of her own pocket for more sessions.

Mari Villar at a therapy session with physical therapist C. Ryan Coxe at Chicago’ s Shirley Ryan AbilityLab. (Jim Vondruska/KFF Health News/TNS)

Millions of Americans rely on physical and occupational therapists to regain strength and motor skills after operations, diseases, and injuries. But recoveries are routinely stymied by a widespread constraint in health insurance policies: rigid caps on therapy sessions.

Insurers frequently limit such sessions to as few as 20 a year, a KFF Health News examination finds, even for people with severe damage such as spinal cord injuries and strokes, who may need months of treatment, multiple times a week. Patients can face a bind: Without therapy, they can’t return to work, but without working, they can’t afford the therapy.

Paulo said she pressed her insurer for more sessions, to no avail. “I said, ‘I’m in pain. I need the services. Is there anything I can do?’” she recalled. “They said, no, they can’t override the hard limit for the plan.”

Mari Villar still can’ t manipulate her right foot nearly two years after a hit-and-run driver smashed into her. (Jim Vondruska/KFF Health News/TNS)

A typical physical therapy session for a privately insured patient to improve daily functioning costs $192 on average, according to the Health Care Cost Institute. Most run from a half hour to an hour.

Insurers say annual visit limits help keep down costs, and therefore premiums, and are intended to prevent therapists from continuing treatment when patients are no longer improving. They say most injuries can be addressed in a dozen or fewer sessions and that people and employers who bought insurance could have purchased policies with better therapy benefits if it was a priority.

Atul Patel, a physiatrist in Overland Park, Kansas, and the treasurer of the American Academy of Physical Medicine and Rehabilitation, said insurers’ desire to prevent gratuitous therapy is understandable but has “gone too far.”

“Most patients get way less therapy than they would actually benefit from,” he said.

Mari Villar has had 11 operations to repair the damage caused when a car crashed into her on a Chicago sidewalk, broke both her legs, and damaged her liver, colon, and one of her lungs. Here she displays one of her surgical scars. (Jim Vondruska/KFF Health News/TNS)

Hard caps on rehab endure in part because of an omission in the Affordable Care Act. While that law required insurers to cover rehab and barred them from setting spending restrictions on a patient’s medical care, it did not prohibit establishing a maximum number of therapy sessions a year.

More than 29,000 ACA health plans — nearly 4 in 5 — limit the annual number of physical therapy sessions, according to a KFF Health News analysis of plans sold last year to individuals and small businesses. Caps generally ranged from 20 to 60 visits; the most common was 20 a year.

Health plans provided by employers often have limits of 20 or 30 sessions as well, said Cori Uccello, senior health fellow at the American Academy of Actuaries.

“It’s the gross reality in America right now,” said Sam Porritt, chairman of the Falling Forward Foundation, a Kansas-based philanthropy that has paid for therapy for about 200 patients who exhausted their insurance over the past decade. “No one knows about this except people in the industry. You find out about it when tragedy hits.”

Even in plans with no caps, patients are not guaranteed unlimited treatment. Therapists say insurers repeatedly require prior authorization, demanding a new request every two or three visits. Insurers frequently deny additional sessions if they believe there hasn’t been improvement.

“We’re seeing a lot of arbitrary denials just to see if you’ll appeal,” said Gwen Simons, a lawyer in Scarborough, Maine, who represents therapy practices. “That’s the point where the therapist throws up their hands.”

‘Couldn’t pick her up’

Katie Kriegshauser, a 37-year-old psychologist from Kansas City, Missouri, developed pregnancy complications that shut down her liver, pancreas, and kidneys in November 2023. After giving birth to her daughter, she spent more than three months in a hospital, undergoing multiple surgeries and losing more than 40 pounds so quickly that doctors suspected her nerves became damaged from compression. Her neurologist told her he doubted she would ever walk again.

Kriegshauser’s UnitedHealthcare insurance plan allowed 30 visits at Ability KC, a rehabilitation clinic in Kansas City. She burned through them in six weeks in 2024 because she needed both physical therapy, to regain her mobility, and occupational therapy, for daily tasks such as getting dressed.

“At that point I was starting to use the walker from being completely in the wheelchair,” Kriegshauser recalled. She said she wasn’t strong enough to change her daughter’s diaper. “I couldn’t pick her up out of her crib or put her down to sleep,” she said.

The Falling Forward Foundation paid for additional sessions that enabled her to walk independently and hold her daughter in her arms. “A huge amount of progress happened in that period after my insurance ran out,” she said.

In an unsigned statement, UnitedHealthcare said it covered the services that were included in Kriegshauser’s health plan. The company declined to permit an official to discuss its policies on the record because of security concerns.

A shattered teenager

Patients who need therapy near the start of a health plan’s year are more likely to run out of visits. Mari Villar was 15 and had been walking with high school friends to get a bite to eat in May 2023 when a car leaped over a curb and smashed into her before the driver sped away.

The accident broke both her legs, lacerated her liver, damaged her colon, severed an artery in her right leg, and collapsed her lung. She has undergone 11 operations, including emergency exploratory surgery to stop internal bleeding, four angioplasties, and the installation of screws and plates to hold her leg bones together.

Mari Villar at a therapy session with physical therapist C. Ryan Coxe at Chicago’ s Shirley Ryan AbilityLab. (Jim Vondruska/KFF Health News/TNS)

Villar spent nearly a month in Shirley Ryan AbilityLab’s hospital in Chicago. She was discharged after her mother’s insurer, Blue Cross and Blue Shield of Illinois, denied her physician’s request for five more days, making her more reliant on outpatient therapy, according to records shared by her mother, Megan Bracamontes.

Villar began going to one of Shirley Ryan’s outpatient clinics, but by the end of 2023, she had used up the 30 physical therapy and 30 occupational therapy visits the Blue Cross plan allowed. Because the plan ran from July to June, she had no sessions left for the first half of 2024.

“I couldn’t do much,” Villar said. “I made lots of progress there, but I was still on crutches.”

Megan Bracamontes’ health insurance allows for only 30 physical therapy sessions a year per person. Her daughter Mari Villar (left) has needed extensive PT after she was hit by a car in 2023. (Jim Vondruska/KFF Health News/TNS)

Dave Van de Walle, a Blue Cross spokesperson, said in an email that the insurer does not comment on individual cases. Razia Hashmi, vice president for clinical affairs at the Blue Cross Blue Shield Association, said in a written statement that patients who have run out of sessions should “explore alternative treatment plans” including home exercises.

Villar received some extra sessions from the Falling Forward Foundation. While her plan year has reset, Villar is postponing most therapy sessions until after her next surgery so she will be less likely to run out again. Bracamontes said her daughter still can’t feel or move her right foot and needs three more operations: one to relieve nerve pain, and two to try to restore mobility in her foot by lengthening her Achilles tendon and transferring a tendon in her left leg into her right.

“Therapy caps are very unfair because everyone’s situation is different,” Villar said. “I really depend on my sessions to get me to a new normalcy. And not having that and going through all these procedures is scary to think about.”

Rationing therapy

Most people who use all their sessions either stop going or pay out-of-pocket for extra therapy.

Amy Paulo, a 34-year-old Massachusetts woman recovering from two operations on her left leg, maxed out the 40 visits covered by Blue Cross Blue Shield of Massachusetts in 2024, so she spent $1,445 out-of-pocket for 17 therapy sessions.

Paulo needed physical therapy to recover from several surgeries to shorten her left leg to the length of her right leg — the difference a consequence of juvenile arthritis. Her recovery was prolonged, she said, because her femur didn’t heal properly after one of the operations, in which surgeons cut out the middle of her femur and put a rod in its place.

“I went ballistic on Blue Cross many, many times,” said Paulo, who works with developmentally delayed children.”

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Amy McHugh, a Blue Cross spokesperson, declined to discuss Paulo’s case. In an email, she said most employers who hire Blue Cross to administer their health benefits choose plans with “our standard” 60-visit limit, which she said is more generous than most insurers offer, but some employers “choose to allow for more or fewer visits per year.”

Paulo said she expects to restrict her therapy sessions to once a week instead of the recommended twice a week because she’ll need more help after an upcoming operation on her leg.

“We had to plan to save my visits for this surgery, as ridiculous as it sounds,” she said.

Medicare is more generous

People with commercial insurance plans face more hurdles than those on Medicare, which sets dollar thresholds on therapy each year but allows therapists to continue providing services if they document medical necessity. This year the limits are $2,410 for physical and speech therapy and $2,410 for occupational therapy.

Private Medicare Advantage plans don’t have visit or dollar caps, but they often require prior authorization every few visits. The U.S. Senate Permanent Subcommittee on Investigations found last year that MA plans deny requests for physical and occupational therapy at hospitals and nursing homes at higher rates than they reject other medical services.

Therapists say many commercial plans require prior authorization and mete out approvals parsimoniously. Insurers often make therapists submit detailed notes, sometimes for each session, documenting patients’ treatment plans, goals, and test results showing how well they perform each exercise.

“It’s a battle of getting visits,” said Jackee Ndwaru, an occupational therapist in Jacksonville, Florida. “If you can’t show progress they’re not going to approve.”

An insurer overruled

Marjorie Haney’s insurance plan covered 20 therapy sessions a year, but Anthem Blue Cross Blue Shield approved only a few visits at a time for the rotator cuff she tore in a bike accident in Maine. After 13 visits in 2021, Anthem refused to approve more, writing that her medical records “do not show you made progress with specific daily tasks,” according to the denial letter.

Haney, a physical therapist herself, said the decision made no sense because at that stage of her recovery, the therapy was focused on preventing her shoulder from freezing up and gradually expanding its range of motion.

“I went through those visits like they were water,” Haney, now 57, said. “My range was getting better, but functionally I couldn’t use my arm to lift things.”

Haney appealed to Maine’s insurance bureau for an independent review. In its report overturning Anthem’s decision, the bureau’s physician consultant, William Barreto, concluded that Haney had made “substantial improvement” — she no longer needed a shoulder sling and was able to return to work with restrictions. Barreto also noted that nothing in Anthem’s policy required progress with specific daily tasks, which was the basis for Anthem’s refusal.

“Given the member’s substantial restriction in active range of motion and inability to begin strengthening exercises, there is remaining deficit that requires the skills and training of a qualified physical therapist,” the report said.

Anthem said it requires repeated assessments before authorizing additional visits “to ensure the member is receiving the right care for the right period of time based on his or her care needs.” In the statement provided by Stephanie DuBois, an Anthem spokesperson, the insurer said this process “also helps prevent members from using up all their covered treatment benefits too quickly, especially if they don’t end up needing the maximum number of therapy visits.”

In 2023, Maine passed a law banning prior authorization for the first 12 rehab visits, making it one of the few states to curb insurer limitations on physical therapy. The law doesn’t protect residents with plans based in other states or plans from a Maine employer who self-insures.

Haney said after she won her appeal, she spaced out the sessions her plan permitted by going once weekly. “I got another month,” she said, “and I stretched it out to six weeks.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.