Physical Therapy and Insurance Coverage

Physical Therapy and Insurance Coverage

Physical therapy may help you to overcome various conditions, injuries, or the effects of an operation. If you attend physical therapy, you may notice that related costs can begin to add up, as you’ll probably need to attend multiple sessions. If you’re unsure about whether your insurance will cover the costs of your physical therapy, you may be in luck. Physical therapy, in many instances, is covered under major medical insurance plans. As an experienced physical therapy provider – including those who practice at MidAtlantic Spinal Rehab & Chiropractic– can confirm, being proactive about your insurance coverage will help you to avoid any cost-related stresses associated with your treatment. Minimizing your stress while recovering is often essential to the healing process. 

When Is Physical Therapy Covered?

One of the biggest rules that insurance has for physical therapy is that it needs to be medically necessary. This means that you probably won’t be eligible for coverage if you need physical therapy to enhance your fitness routine. However, if you have a spinal cord injury and need physical therapy to recover some function, then this would be considered a medical necessity.

In addition to helping you recover from injuries, surgeries, and other conditions that affect your mobility, you may be able to have physical therapy covered by your insurance if it is considered preventative care. For instance, some seniors require physical therapy to help them maintain their strength and balance to not have avoided devastating falls. 

How To Make Sure Your Treatment Is Covered

Before your treatment, check with your insurance provider to ensure that you have coverage. Ask plenty of questions about your coverage and explain your situation to the insurer. This can help you avoid your claim being denied later or you receiving surprise medical bills. Some insurance companies have a maximum dollar amount that they will pay for. Your insurance may have a limit per injury or a limit per dollar. For example, you may be able to receive different treatments for different injuries with their own set dollar amount. In other cases, you would have to add up the cost of both.

Before you receive therapy, ask about in-network and out-of-network physical therapists. Some companies allow you to see an out-of-network therapist for a fee, whereas others may not allow you to go to an out-of-network physical therapist. If you’re worried about your insurance covering it, make sure to discuss your situation in advance. For patients without coverage, go to your physical therapy office and discuss payment plans or other options to help pay for your procedures.