Is Physical Therapy Covered by Insurance?

There are many cases in which a doctor may decide that you need physical therapy. The good news is that in many cases, your insurance will cover the cost of physical therapy. But how do you find out if you have physical therapy coverage? And how do you use insurance for physical therapy?

Essential Benefits

In order to use insurance for physical therapy, your sessions need to count as an “essential benefit”. Most health insurers offer ten “essential benefits” – under the law, most plans must cover anything that falls within this category. In the case of physical therapy coverage, this could include:

  • Preventive and wellness care
  • Management of a chronic condition
  • Rehabilitative services

If your doctor does not prescribe physical therapy as an essential benefit, it may not be covered by your insurance plan. Before going to your first appointment, check with your insurer to find out if your physical therapy is covered by your insurance plan. It is also a good idea to find out if you will be required to pay part of the fees or if your physical therapy will be fully covered.

Health insurance policies provide coverage for physical therapy by a licensed physical therapist in cases where sessions are rehabilitative and medically necessary. You may need to obtain a note from your doctor’s office to include in your record that states that you need physical therapy. Check with your insurance provider to determine what is necessary as requirements for eligibility can vary from state to state.

Know Your Limits

It’s important to get all the details about your coverage, including things like lifetime maximum, annual, or “per-condition” limits. Can you file multiple claims if you need physical therapy for more than one condition in a year? Does your coverage change if you have one condition or two separate conditions? Is there a limit to each type of coverage individually, or for coverage for physical therapy in general?

Know your deductible so that you know when you need to pay for services and when insurance will cover your physical therapy. You will also want to be familiar with your “out-of-pocket maximum”: the most that you can be made to pay per year under your coverage plan. Once you have reached your out-of-pocket limit, any and all other physical therapy should be covered, although this is often subject to the terms of your health care plan.

Some plans put a limit on the number of sessions you can attend up to the first 90 days after you have enrolled in the plan. Should this happen, discuss your situation with your doctor and find out if your doctor can contact your insurer to arrange a waiver for treatment that must take place immediately.

Choose Wisely

Check with your insurance provider to find out if you are required to use an in-network physical therapist or if your physical therapy coverage allows you to choose any physical therapist. Find out if there are limits on physical therapy coverage for out-of-network physical therapists, and compare the cost for in-network care, as different providers may charge different fees and end up being cheaper than in-network physical therapy. You can also ask your doctor for recommendations.

In some cases, you may need special equipment to complete your physical therapy. Be sure to check with your insurer to find out if they cover special equipment. Some plans will reimburse you for equipment, while others will expect you to pay this separately.

Just as we are interested in helping you feel better physically, we are also dedicated to helping you understand your coverage. Our front office team will verify and review your insurance benefits during your first visit to help you understand what you should expect. We provide a full-time administrative staff to help you determine if your insurance will cover physical therapy and what kind of coverage you will receive. In addition, we offer an $80 per visit self-pay rate for patients without insurance, and we offer flexible repayment plans for patients with high deductibles.

In most cases, you can expect to receive a high level of physical therapy insurance coverage. Be sure to ask your insurer plenty of questions and don’t be afraid to ask us when you are unclear about your coverage. Visit our Insurance Participation page to learn more, or call (434) 817-0980 to schedule your new patient evaluation today.