Amelia Grant

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Author: AmeliaGrant

What to Know About Physical Therapy and Insurance

Your insurance plan may partially or completely cover physical therapy (PT). However, before your insurance will pay for PT, your healthcare provider must confirm that it is medically necessary. This is true for private and other insurance plans, such as Medicare and worker's compensation.

Physical therapy usually necessitates several sessions. Even if your insurance covers physical therapy completely, the costs of physical therapy can quickly add up due to co-pays. If you only have partial coverage, you must account for that cost as well as the portion of the service fee that you must pay.

Questions to Ask Your Insurance Company
Is Physical Therapy Covered as Part of My Plan?
First, you should determine whether your insurance plan covers physical therapy and, if so, what costs you will be responsible for.

If it isn't covered, you'll pay the rate agreed upon by your insurer and the physical therapist. If you have coverage, find out if you have to pay copays or coinsurance.

The majority of people pay a co-payment of $25 to $35 per therapy session. Some co-payments, however, can be as high as $50 or $75.

If you have Medicare as your primary insurance, your plan will likely cover about 80% of your PT claim, with you on the hook for the remaining 20%. 

What Is Insurance Cost-Sharing?
Many people have insurance plans that include cost-sharing. In this arrangement, your insurance carrier covers some of the costs of services, while you are responsible for others.

You may also be required to pay a co-payment each time you visit your therapist. You may also have a deductible to meet each year before your insurance coverage begins to pay for physical therapy.

Is a Referral Needed?
You may need a referral from a medical provider stating that the PT is medically necessary for coverage to kick in, and in some cases, certain tests, such as imaging as part of a diagnosis, may be required.

Are there Limits on the Coverage?
If your insurance covers physical therapy, find out if there are any limitations. For example, sometimes there is a limit on the number of appointments per year or per condition that is covered.

Do I Need to Stay In-Network?
Check with your insurance company to see if you need to stay in-network. If you have the option to go out of network, inquire about the cost difference between in-network and out-of-network providers.

Once you've decided on a physical therapist, find out if they're a provider with your health insurance company. Staying in-network can help you save money.

Does the Plan Cover PT Equipment?
As part of your therapy, your physical therapist may recommend that you use certain equipment or devices at home. Check with your insurance company to see if this is covered.

Questions to Ask Your Physical Therapist
How Are Therapy Services Billed?
Understanding how therapy services are billed will assist you in determining your out-of-pocket costs.

Physical therapists bill for their services based on what they do during sessions. For example, your initial evaluation is typically billed at a higher rate than follow-up sessions. Your therapist may bill for the various treatments performed during follow-up therapy sessions.

Co-Payments Can Add Up
PT is frequently ongoing and does not consist of a single appointment. Depending on your recovery, you may need to go several times per week for weeks or months. Even if your session co-payment is small, the costs can add up over time.

What Are the Costs Without Insurance Coverage?
If your insurance does not cover PT or only covers a portion of it, you will have to pay for some or all of it yourself. Tell your therapist's office that your insurance will not cover your PT and that you will have to pay out of pocket.

Your therapist's office can provide you with a fee schedule that details the charges for each individual service that your therapist will provide.

How Do Sliding Scale Payments Work?
If you do not have health insurance, physical therapy costs between $125 and $150 per session. Your physical therapy office will collaborate with you to provide the best care at the lowest possible cost.

For example, they might set up an interest-free payment plan that you can pay off over time rather than in one lump sum.


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