Does Health Insurance Cover Physical Therapy?

Whether you have been involved in an accident, you have suffered an injury, or you have undergone a medical procedure that requires the strengthening of your muscles (a knee replacement, for example), physical therapy may have been recommended for you.

Physical therapy has been proven to restore function in damaged joints and muscles, relieves pain, and improves mobility. Given the positive benefits that this type of treatment can offer, it’s no wonder why it is often recommended by healthcare professionals and why millions of Americans seek physical therapy treatment each year. However, while physical therapy may be beneficial, that doesn’t mean that your health insurance will cover the expense.

The Benefits of Physical Therapy

physical therapistPhysical therapy involves the use of a variety of modalities that aim to restore function, relieve pain, and enhance mobility in patients who are suffering from a variety of conditions. While this type of therapy is often used to treat chronic back pain, pulled muscles, and torn ligaments, it can also be an effective remedy for a variety of other ailments and conditions that affect the body physically. Some of the conditions that physical therapy can treat include:

  • Joint replacement surgery
  • Burns
  • Chronic migraines and tension headaches
  • Osteoporosis
  • Arthritis
  • Incontinence
  • Pain in the pelvic region
  • Disorders of the musculoskeletal system
  • Lymphedema
  • Traumatic brain injuries (TBIs)
  • Strokes
  • Vestibular disorders

Additionally, physical therapy can be used to assist young children who are experiencing delays in gross motor development. Furthermore, this type of treatment can help to restore balance and improve muscle control. In short, physical therapy can be a highly effective way to treat a variety of conditions in people of all ages.

Physical therapy does more than just enhance mobility, strengthen the function of the joints and muscles, and relieve pain; it can also be an effective way to:

  • Prevent injuries from occurring; for example, athletes may participate in physical therapy to avoid tearing ligaments.
  • Ease or delay the symptoms that are associated with chronic degenerative diseases
  • Minimize the need for prescription drugs, such as opiates
  • Reduce the need for surgery

It can even be used to diagnose certain medical conditions and to improve or maintain overall health and well being.

Health Insurance and Physical Therapy

While the benefits of physical therapy are clear, that doesn’t mean that health insurance will cover the treatment.

If you are in need of physical therapy, you are probably wondering, “Will it be covered by my health insurance?” The answer, like so many other questions related to health insurance, is this: it depends. It depends on the specific health insurance company that issues your policy, as well as the specific policy that you hold. Simply put, physical therapy is covered by some health care insurance, and others don’t provide coverage at all; likewise, some plans will cover certain forms of physical therapy, but not all of them.

There are a number of factors that will determine whether or not a healthcare plan will cover all or some of the costs of physical therapy. For instance, employer-sponsored group policies are the most likely to offer coverage for this type of care. Some individual policies, particularly those that are purchased through the Affordable Care Act’s marketplace, will offer coverage for this type of treatment; however, these policies usually offer limited coverage.

The Cost of Physical Therapy

If your health insurance plan does offer coverage for physical therapy, it’s important that you find out exactly what is covered. For instance, while your provider may cover this type of care, they may not cover specific forms, or they may only cover a certain amount of sessions or session lengths. Likewise, if you use an out-of-network physical therapist, your health care plan will likely not cover the expense.

There are various forms of physical therapy, and some types are more expensive than others, which is why certain insurance plans may only cover selective treatments. Additionally, if your rehabilitation plan requires lengthy visits over a prolonged period of time, your insurance plan may not cover all of the care that you require. Furthermore, it’s important to understand that even if your medical plan will cover all or some of your physical therapy, it may not cover the cost of any assistive devices that might be required.

Summing It Up

If you are in need of physical therapy, don’t assume that just because you have insurance the treatment will be covered. There are a variety of factors that are taken into consideration when an insurance provider decides whether or not they are going to offer coverage for physical therapy. To find out if your policy does provide coverage – and if so, how much – contact your provider, or better yet, speak to a reputable health insurance agent.

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