Does insurance cover physical therapy? What You Need to Know

Does insurance cover physical therapy?

The expenses associated with physical therapy (PT) can fluctuate, contingent upon your health insurance coverage.

Your insurance might partially or fully cover physical therapy.

To ascertain coverage, your healthcare provider needs to confirm its medical necessity.

This applies across various insurance plans, encompassing private, Medicare, and worker’s compensation insurance.

Given that physical therapy often requires multiple sessions, even with full insurance coverage, expenses can accumulate due to co-pays.

If your insurance only offers partial coverage, you’ll need to consider both the covered portion and the portion you’re accountable for paying.

Does insurance cover physical therapy
Does insurance cover physical therapy
source : thumbor.forbes

Understanding the costs of physical therapy with or without health insurance is crucial.

Does insurance cover physical therapy?

ACA-compliant and state-marketplace health insurance plans encompass ten essential benefits mandated by law.

Coverage for these benefits is obligatory within these plans. However, this doesn’t limit PT coverage solely to marketplace-bought insurance.

If you have a federally qualified HMO plan through your employer, it should also cover PT.

Usually, your insurer will communicate one of three things:

  1. PT isn’t covered: You pay the rate set by your insurer with the physical therapist.
  2. PT is covered: Your insurer pays a percentage (coinsurance) of the bill.
  3. PT is covered: You pay a fixed fee (copay) for your visit.

Moreover, some physical therapy may receive coverage if it’s preventive, aiming to reduce the likelihood of injury or illness.

For example, your insurance plan might include coverage for physical therapy aimed at preventing falls among older people living in community settings.

What Are the Costs Without Insurance Coverage?

If your insurance doesn’t cover or offers partial coverage for physical therapy, you’ll need to cover some or all of the costs yourself.

When contacting your physical therapist’s office, inform them of your insurance limitations and that you’ll be paying directly.

The office can furnish a fee schedule detailing charges for each service provided by your physical therapist.

After obtaining this schedule, discuss it with your therapist. Ensure clarity on the services offered and billed.

Evaluate if the treatment plan aligns with your budget.

For instance, if your therapist plans electrical stimulation, therapeutic activity, and exercises, tally the cost of each service to estimate the total session expenses.

Factors That Affect PT Cost

Several factors influence the potential costs of physical therapy. Being mindful of these aspects when estimating expenses can aid in preparation.

Surgery or Injury Recovery:

  • Minor injuries like sprains may require only a few PT sessions for guidance during healing. Self-care exercises provided by your therapist could mean a total cost of less than $100 with insurance or a few hundred dollars uninsured.
  • Major surgeries, such as joint replacements or fracture repairs, might entail several months of PT, resulting in significant out-of-pocket expenses.

For planned surgeries, budgeting in advance can be beneficial.

Having extra funds to cover frequent co-payments over several months can ease the financial burden.

Equipment:

  • Your therapist might recommend purchasing items to assist in recovery, which you’ll likely need to pay for independently.

Examples of items include lumbar rolls, exercise balls, or resistance bands. Insurance coverage for these items can vary.

Ask your therapist for cost-effective options if they suggest purchasing any.

Remember, top-tier equipment isn’t always necessary.

You might even create some items at home, like a lumbar roll or shoulder pulley, reducing costs.

How to Reduce Physical Therapy Costs

You might discover limitations in your health insurance coverage for physical therapy or encounter high out-of-pocket expenses, even with partial coverage.

In such situations, exploring the possibility of using your HSA or FSA for medical payments can be helpful.

These accounts enable pre-tax allocation of funds for medical expenses, reducing the taxable income used to cover the bills.

PT prescribed by a doctor as part of your care plan qualifies as a medical expense for HSA benefits.

If you lack an HSA or FSA, there are alternative methods to mitigate PT costs.

Some physical therapists offer discounts for multiple sessions.

Seek information from your doctor’s office or hospital about potential medical financing options or available discounts.

Conclusion

The expense of physical therapy (PT) varies depending on the treatment type, duration of therapy needed, and your insurance coverage.

For insured individuals, contacting your health insurance provider to inquire about PT coverage before scheduling an appointment is advisable.

Even with coverage, be prepared for session co-payments.

If you lack insurance or your plan excludes PT, self-payment is necessary.

Discussing cost-saving strategies with a therapist, like payment arrangements or home exercises, is worthwhile.

Partnering with a physical therapist is pivotal for recovery from injury or surgery.

However, the high cost of therapy might hinder potential benefits from PT sessions.

If cost poses a barrier to treatment, consider reaching out to your provider or a local PT office to explore affordable care options available to you.

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