When you visit your Atlanta physical therapy office, the last thing you want to do is worry about whether or not you can afford treatment. Because physical therapy typically involves multiple sessions across weeks or months, the costs can add up. That’s why you want to know if your health insurance plan covers physical therapy. Here’s what you need to know about physical therapy, including questions to ask your insurance company and how to get the most out of your time with a physical therapist.
What to Expect with Physical Therapy
Many health care plans cover physical therapy as an “essential benefit.” Typically, physical therapy is covered by insurance when it offers one of the following benefits for you.
Rehabilitative Care
Physical therapists provide rehabilitative care for health conditions or injuries that affect your physical health. Physical therapy helps restore, maintain, or improve your healthy functioning and quality of life. If you recently suffered injuries, like a car accident injury, that has affected your strength and mobility, then a physical therapist can help you get back or improve your skills and functioning. If you are recovering from a surgical procedure, physical therapy can help restore any lost functioning like range of motion or flexibility.
Managing a Chronic Condition
Physical therapy assists people with chronic health conditions to improve their strength, mobility, and flexibility. Chronic health conditions like arthritis or multiple sclerosis may result in a steady decline in muscle strength or overall functioning. A physical therapist can work with you to limit weakness or limited mobility due to a chronic condition. Strength training exercises and increasing flexibility help those with chronic conditions become more stable and reduce the likelihood of additional injuries.
Preventative and Wellness Care
Preventative physical therapy helps patients manage their health before an illness or injury negatively impacts healthy functioning. Your doctor may recommend physical therapy to help you safely participate in physical activities you enjoy. Physical therapy for preventative and wellness care can provide you with stretches, exercises, and other tools to strengthen the body and improve mobility. A physical therapist for preventative and wellness care can also help identify potential problem areas and work to reduce the risk of developing into a more serious issue.
Questions to Ask Your Insurance About Physical Therapy
Health insurance plans differ from patient to patient, so it is important to find out details about whether your insurance covers physical therapy. Here are seven examples of questions to ask your insurance company about physical therapy.
Is physical therapy covered by my insurance plan?
Most insurance companies include physical therapy as part of the “essential benefits” of health care. Your insurance company should be able to tell you if physical therapy is covered and whether you will need to pay a flat fee or a percentage of the bill. Avoid the issues of complicated billing requirements for physical therapy by contacting your insurance provider before starting with a physical therapist.
Is there a copay for physical therapy?
A copay refers to the flat fee for a visit to the physical therapist. Your insurance company may require you to pay a copay even if physical therapy is covered by your health care plan.
Is there a deductible for physical therapy?
Some health care plans require you to meet a deductible before insurance covers all or some of your physical therapy costs. Find out if your insurance plan has a deductible and what amount you would need to reach before some or all the treatment would be covered.
Is there a limit to how much physical therapy I can receive?
Some health care plans may limit the number of visits covered by insurance or limit the time period in which you can receive physical therapy. Your insurance may not cover physical therapy or other services during the first 90 days of your coverage. Talk to your insurer to find out more about a limit on the number of visits or time frame for physical therapy or if you have unrestricted access to physical therapy.
Does a physical therapist need to be in-network?
In some cases, your insurance company may require you to see a physical therapist in-network for you to receive full coverage for treatments. Additionally, some physical therapists specialize in certain areas and may not be the best fit for your needs. Visit your health care plan’s website to search for in-network physicians and find out more about the costs and barriers to physical therapy care.
Does my insurance plan cover equipment or devices?
If your physical therapist recommends equipment or devices to help you continue your therapy at home, then your insurance may cover those items. Some health care plans may cover visits to the physical therapist but not the cost of equipment. Contact your insurance to find out about coverage or reimbursement options for physical therapy equipment or devices.
Do I need a referral from my doctor?
Some insurers will require a referral from your doctor in order to cover any physical therapy sessions. Find out before you start treatment with a physical therapist if your insurance company requires a referral. Even if you do not need a referral for insurance purposes, you may request one from your doctor for a personalized recommendation to best address your health care needs.
Benefits of Physical Therapy
Physical therapists are trained and licensed to diagnose and treat a range of injuries, health conditions, and disabilities that affect your mobility. Part of your recovery and improvement process can also involve gaining the confidence to return to activities you enjoy safely and successfully. Physical therapy has a wide range of benefits.
Reduce Pain
Physical therapy offers an alternative option to pain medication when recovering from an injury, surgery, or dealing with chronic pain. Learn how to reduce your pain through stretches, exercises, and other activity-based treatments with a physical therapist. Instead of prescribing medications, physical therapists prescribe various physical activities and manual therapies to help reduce pain naturally. Physical therapy can also help decrease inflammation that may be contributing to your pain after a recent injury or surgery.
Improve Strength
Progressive strengthening can help you recover faster from injuries and going to a physical therapist can help you improve your overall strength. After an injury or surgery, limited mobility may cause your muscles to weaken, and you may lose strength and flexibility as a result. A physical therapist can help you improve your strength through a series of personalized stretches and exercises that address your target areas and goals for improvement. As you work to strengthen these areas, physical therapy can also help you improve your balance and stability.
Increase Range of Motion
When you are in pain, you may avoid certain movements or motions that make that pain worse. This can result in a decreased range of motion and flexibility over time. A physical therapist can help you increase your range of motion after an injury or surgery by gently restoring mobility to your soft tissues and joints. Stretches and exercise help engage weakened muscles, tendons, and joints to help encourage greater mobility.
Recover from Injury
An injury can cause lasting, long-term effects when not treated properly. Physical therapy immediately after an injury can help you avoid long-term damage and decrease the physical effects of an injury. When you work with a physical therapist to recover after an injury, they can help you regain strength, mobility, and return to your regular activities. Physical therapy after an injury can also help you prevent the risk of additional injuries or falls in the future.
Manage Health Condition
Physical therapy can also teach you how to manage a health condition to reduce pain and improve mobility. Your doctor may recommend physical therapy to avoid surgery or to help you better prepare for surgery. In some cases, physical therapy can help set you up for a more successful recovery from a surgical procedure. In other cases, a physical therapist can help you avoid surgery altogether due to the progress you’ve made in physical therapy.
At AICA Orthopedics, our physical therapists are movement experts who provide each patient with a personalized plan for treatment. Visit an AICA Orthopedics location near you to get started with one of our physical therapists. Our team of multi-specialty physicians and professionals can also provide you with guidance and support as you navigate what can seem like a complicated process for insurance and health care coverage. We are here to help support you and meet your goals so you can feel better and recover effectively!
