Does Health Insurance Cover Physical Therapy?
Health insurance usually covers some level of physical therapy, although each plan has its own set of specific stipulations. Plans are most likely to cover physical therapy when it is deemed a medical necessity by a healthcare professional.
You may need a doctor’s referral to receive coverage for your physical therapy. You may additionally need to meet a variety of eligibility requirements dictated by your health insurance policy.
What types of eligibility requirements would apply to physical therapy?
In addition to being declared a medical necessity, your physical therapy sessions could be limited to the type of condition they are treating. Not all health insurance plans may cover pre-existing conditions, chronic conditions, or those that do not fit a specific clinical diagnosis or condition.
Chronic conditions, such as arthritis, may not be the only conditions excluded. Some plans may not cover physical therapy for learning disabilities or brain damage caused by anything other than an unintended injury.
Health insurance companies may also steer clear of coverage for conditions that are not likely to improve with therapy. Health insurance plans often cover the therapy for a very limited set of time and only if you are expected to improve within that amount of time.
Your plan may have a set number of visits you are allowed per year or a set amount of coverage for the year or the plan’s lifetime. You may need to obtain not only a referral from a provider, but also pre-certification from your insurance company to even begin a physical therapy program.
Where you receive your physical therapy can be an eligibility concern. Plans may have a network of physical therapists for which coverage is extended. Others may only cover physical therapy from a certain type of provider. Plans may cover only office visits and not home-based physical therapy. An exception may be offered for those who are unable to leave their homes due to their injury or condition.
What do physical therapists do?
The main goal of a physical therapist is helping people recover their mobility after an injury or accident. They can also help those suffering from chronic conditions, such as arthritis, improve their mobility, and reduce pain levels.
The U.S. Bureau of Labor Statistics outlines several specific duties of a physical therapist. These include diagnosing any dysfunction in a person’s physical movements, coming up with a treatment plan that helps to correct the dysfunctions, and helping a person achieve the goals set forth in the plan.
Physical exercise is a major component in a physical therapy plan. It generally consists of repetitive stretching and mobility exercises targeting the affected areas. Someone who has problems moving their hands and wrists due to arthritis, for instance, may have a series of specific hand and wrist exercises to follow.
In addition to stretching, exercises can include strength training, isometrics, massage, and other therapeutic techniques. Patients may also work with specific equipment that helps restore optimum functioning.
Physical therapists not only design a treatment program but they also monitor it to ensure progress is being made. Additionally, they educate the patient and patient’s family on the nature of the treatment plan and the patient’s condition, offering ways that home life can be made easier for the person in therapy.
Do they only provide treatment if you’re injured or ill?
The American Physical Therapy Association points out that the physical therapist can also play a role in treatment meant to reduce the risk of future injuries or conditions and prevent future health issues. This can come into play for people who are in a specific population group or are genetically predisposed for a specific condition.
Here the physical therapist, or PT, would outline a plan that provides education and exercises to hopefully keep that specific condition at bay. Physical therapists typically work as part of an overall healthcare team, especially in such situations, where other areas of concern may be nutrition and weight maintenance or reduction.
Are there different types of physical therapists?
As with most healthcare professionals, physical therapists often specialize in a specific area of care. Some may focus on helping athletes recover from injuries while others will work mainly with children. Still others may focus on helping geriatric patients or people suffering from specific conditions.
How do I find a physical therapist?
Asking your primary care physician or other healthcare professional for a referral may be a good place to start your search for a physical therapist. You can also ask other trusted individuals, such as family members and close friends.
Reviewing the list of physical therapists in your insurance company’s network is another good idea, since their services are most likely to be covered by your plan. If you need to go outside the network, some insurance companies may still cover part of the cost. In addition to ensuring the PT has experience treating your condition, you also want to ensure he or she has the proper state licensing and certification in place.