Going Back and Forth with Your Insurance Provider Over Physical Therapy Coverage? A Cash-Based Model of Care like Purpose Physical Therapy’s Might be the Answer.

by | Sep 10, 2021 | Sports Injuries

Physical therapy coverage can be difficult to figure out, and too many patients who are in need of these services end up being told that, for a number of different reasons, service will not be provided. Insurance coverage for physical therapy is often both specific and limiting, but what does it actually cover? What are your options for receiving quality, affordable care in the face of a coverage denial? Today, we’re going over why insurance coverage is so limiting when it comes to physical therapy – and how you can still receive great care.

The Basics of Insurance Coverage

Insurance companies generally cover physical therapy services that are deemed “medically necessary” (for more info on what that means, check out another one of our blog posts). Essentially, medically necessary care is given as a direct result of a recent accident, injury, or illness. Because “medically necessary” care is reactive and targeted at one specific injury or pain, it is hardly ever holistic. That is, it serves to treat the afflicted part of the body and little else. On top of that, the time span insurance coverage is often very limited.

Most insurance companies put a monetary or time-driven cap on their coverage. After that cap of time or money, your physical therapy care costs will have to be taken care of out of pocket. The exact caps, limitations, and copays vary between different insurance companies, but patients across the board must face a great deal of bureaucracy and restriction when looking for physical therapy that’s covered by insurance.

When Insurance Coverage Works – and Doesn’t

Of course, insurance coverages will always vary by company and plan. Generally speaking, though, going with a physical therapy plan that’s covered by insurance can be a good idea if you require very targeted, limited care. However, if you are looking for comprehensive physical therapy, physical therapy that is preventative, or physical therapy that integrates your specific injury treatment into whole-body improvement, it might be a good idea to opt out of insurance coverage.

This is because insurance hardly ever covers preventive physical therapy, and it can be very difficult to cover old aches and pains, too. This is denied under the guise of “medical necessity,” despite the fact that preventive physical therapy can be life-changing. It can improve overall strength, flexibility, and mobility; it can reduce the risk of serious injury in a slip, fall, or accident as you age; it can boost mindfulness and confidence; and it can stave off certain illnesses, like heart disease or arthritis. Despite what insurance companies try to tell you, preventive physical therapy is an effective, useful, and important tool for long-term wellness.

Cash-based Physical Therapy

If you’re looking for physical therapy that’s holistic, preventative, or that covers an old pain, a cash-based model of care might be the answer. Cash-based physical therapy operates without any of the limitations of insurance (in fact, this freedom to tailor treatment to every patient is the reason behind Purpose’s entirely cash-based model). In fact, “cash” is just a figure of speech: at Purpose, care can be paid for using credit or debit cards, as well as FSA and HSA accounts. By circumventing the restrictions put forth by insurance, cash-based physical therapy can accomplish a lot: it can target your injuries and pains while promoting whole-body health; it can evolve as your physical needs change over time; it can focus on both short- and long-term improvements without rushing your body to perform based on an arbitrary bureaucratic timeline. If you’re interested in learning more about the benefits of cash-based physical therapy, don’t hesitate to reach out to us.
Physical therapy coverage can be tricky, at best, to figure out – but there are options available to you beyond the limitations of insurance. Curious about how a cash-based model would work with your needs and lifestyle? Schedule an initial evaluation with us and claim our exclusive new patient offer.
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