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
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?
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?
Are there Limits on the Coverage?
Do I Need to Stay In-Network?
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?
Questions to Ask Your Physical Therapist
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
What Are the Costs Without Insurance Coverage?
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?
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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