Does Insurance Cover Physical Therapy?

Many doctors prescribe physical therapy to help their patients recover mobility following injuries or to help them overcome the physical limitations due to chronic medical conditions. Therapy sessions usually take place over weeks or months, with costs easily exceeding some patients’ budgets. 

What Are The Goals of Physical Therapy?

Patients may undertake physical therapy to achieve various outcomes, including:

• Chronic pain management
• Balance improvement
• Injury recovery
• Fall prevention
• Paralysis recovery
• Mobility improvement

Physical therapists may apply various treatments, including hot and cold compresses to improve flexibility and reduce swelling, manual manipulation to stretch muscles, and ultrasound or electrical stimulation to improve blood flow and reduce pain. 

Will Insurance Cover Physical Therapy?

Coverage for physical therapy sessions depends on various factors, starting with a policy’s terms. For example, although most policies do cover physical therapy services in Bowie, MD, like ones offered at Mid Atlantic Spinal Rehab & Chiropractic, individuals may need to submit a doctor’s prescription indicating that treatment is medically necessary before they can receive benefits.

Few insurance providers cover the total cost of physical therapy, but they may require patients to choose among providers within a pre-arranged network to ensure any coverage. Some insurance providers will still cover some of the cost of using out-of-network providers, but to a lesser extent than when patients select providers from their preferred networks.

Insurance policies often require patients to meet pre-determined deductibles before their coverage activates. Deductibles are payment thresholds that insured individuals must meet out-of-pocket and may differ when using in-network and out-of-network providers. Once patients complete their deductible obligations, they may pay for a percentage of each therapy session or a flat fee per session. 

Some insurance policies indicate a maximum out-of-pocket amount that patients must pay before their policies cover the total cost of physical therapy. Policies usually require insured individuals to submit periodic doctors’ evaluations or new prescriptions to prevent the high costs of unnecessary visits. Failure to provide updated doctors’ feedback can lead to coverage denials.

Physical therapy involves weekly commitments from patients and therapists; however, patients may sometimes experience scheduling conflicts that require them to cancel sessions. Although rescheduling or canceling sessions typically does not affect coverage, failure to show up to a session without alerting a therapist could result in non-coverage for the session.  

Most insurance companies provide physical therapy coverage to help people live pain-free and mobile lives. Be sure to know the terms of your policy to ensure that you receive the full extent of your policy’s coverage.