A Physical Therapist’s Guide For What To Do if Your Insurance Doesn’t Cover the Physical Therapy You’re Looking For.

by | Oct 8, 2021 | Sports Injuries

If your insurance doesn’t cover physical therapy services that you need, it can feel like you’ve hit a dead end. That’s why it’s so important for you to know what all of your options are when it comes to getting care. If you feel as though you’ve hit a wall in your search for quality physical therapy services, we’re here to help. Today, we’re going over why it is that insurance may have denied coverage of your physical therapy treatment, along with the options that are still at your disposal for getting effective, results-driven care. Let’s get started.

“Medically Necessary” for Insurance Purposes

Most insurance companies offer some degree of coverage – be it partial or total – for physical therapy services that they deem “medically necessary.” Medically necessary physical therapy is defined as being essential in the treatment or diagnosis of an illness, injury, condition, or symptom. The most textbook example of physical therapy that is considered “medically necessary” for insurance purposes is care that you would receive in order to be rehabilitated after being injured in an accident. Other examples of commonly accepted forms of “medically necessary” physical therapy include rehabilitation after the loss of limbs, fractures, or major surgery.

The problem with “medically necessary” definitions is that it places constraints on the type of affordable care that’s available to patients. This is because the definition refuses to acknowledge care that may not be reactive to a specific catastrophe but is useful and life-altering all the same. As a result, this puts physical therapists – and patients – between a rock and a hard place. Two of the most common examples of this are preventive and long-term physical therapy.

The Importance of Preventive & Long-term Care

If you have an old pain that you can’t trace back to a particular accident, you may find yourself having trouble getting physical therapy treatment covered for it by insurance. That’s because, despite significantly affecting your quality of life and preventing the injury from becoming worse down the line, the treatment may not be considered medically necessary for insurance purposes. The same might be said for preventive care: if you have a history of arthritis in your family and are looking into physical therapy solutions to help stave off symptoms before you develop them yourself, you might be hard-pressed to find coverage. The same goes if you were receiving physical therapy for an injury sustained in a catastrophic event, have recovered from the injury, and are looking for a more holistic or long-term physical therapy solution.

Preventive, long-term physical therapy may not fall under the vague umbrella of “medically necessary” for insurance purposes, but that doesn’t make it any less legitimate. In reality, this type of care can be life-changing: it can reduce the risk of heart disease, prevent bone diseases like arthritis and osteoporosis, boost mindfulness and improve mental health, maximize strength and mobility, and provide a number of other essential services for long-term mind and body wellness. If you’re looking for a physical therapy service that falls outside of the “medically necessary” insurance umbrella, you should not give up; there are options available to you that circumvent the bureaucracy and limitations of insurance.

A Cash-based Option

Here’s the thing: we understand that choosing a physical therapist is an important and difficult decision, and it’s one that should be made taking all of your circumstances into consideration. With that said, if you’re willing to look beyond the options outlined by your insurance company and to explore your options for holistic or long-term care, it’s worth remembering that you do have options beyond insurance.

Cash-based physical therapy shirks the restrictive model of insurance altogether, opting instead for a limitation-free model of care that places the needs of each patient above anything else. Every cash-based approach is different, and at Purpose PT’s cash approach exists because we want to give our patients options beyond the rigid guidelines of insurance companies. Practicing as a cash-based provider allows us to tailor our plans to each patient; it gives us the freedom to work with all of our patients to create treatment plans that evolve as their needs do. We’re not here to tell you that cash-based physical therapy is the best choice for you; our goal is to make sure that you know it does exist as an option if you’re looking for holistic, patient-centered care.

If you’re concerned about the fact that your insurance doesn’t cover physical therapy services you want or need, we’ve got you covered. Reach out to us to learn more about our cash-based model and receive an exclusive new patient offer.
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