How does health insurance affect physical therapy? It happens often. Find out what you can do about it.

by | Jul 9, 2021 | Sports Injuries

Can health insurance affect physical therapy? The answer is yes – and, regardless of your provider or medical needs, it’s in more ways than one. Insurance companies are notorious for setting parameters and limitations when it comes to physical therapy care. From the length of time for which your care is covered to the physical therapist you work with in the first place, the decisions you make about physical therapy are crucial. If you choose to go through insurance, they’re also likely to be highly influenced by your provider. Today, we’re going over the general stance when it comes to health insurance companies’ physical therapy coverage – and what you can do in order to receive exactly the care you need for a manageable price. Let’s get started.

The Health Insurance Policy

Of course, no two health insurance providers are the same. It’s crucial that you look at your own policy to find out exactly what the physical therapy coverage terms are. With that said, the general stance is that health insurance will cover physical therapy services (either fully or partially) that are deemed “medically necessary” for a limited period of time. The length of time for which physical therapy is covered and the amount that the policyholder is responsible for paying out of pocket will vary depending on the insurance provider. However, across providers and locations, “medically necessary” is a consistent qualifier for physical therapy coverage.

Defining “Medically Necessary”

Medicare defines “medically necessary” services as “health-care services or supplies needed to diagnose or treat an illness or injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” According to this definition, physical therapy services that are covered by insurance must be reactive. That is, they are provided as a direct result of a recent accident, injury, or illness.

Though this is the widely accepted insurance approach to physical therapy, its real-life applications are far more varied. Physical therapy extends far beyond the services that are simply reactive. In fact, some of the most effective and life-changing physical therapy treatment available is preventative.

Preventative Care Explained

You’ve probably heard of preventive care in the context of primary medicine and family physicians. However, it’s also very much a thing in the world of physical therapy. Preventive physical therapy doesn’t just seek to treat an existing injury or pain; it aims to strengthen your body and improve your mobility in order to reduce the likelihood that injuries and pain will happen in the first place. Preventive physical therapy can be used in tandem with reactive treatment. That is, it’s completely possible (and advisable) to work on overall mobility and strength-building while treating a specific injury, rather than just honing in on one pain point over the entire course of your treatment. The best solution for long-term wellness is a holistic approach that integrates your injury or pain into your overall health and fitness; think of it as having a strength coach, trainer, and doctor of physical therapy all in one.

By taking a holistic approach to care, a preventative physical therapist helps to maximize overall strength, reduce the risk of injury down the line, and help to reduce the negative side-effects of existing injuries and pains. Unfortunately, preventative physical therapy is hardly ever covered by insurance due to the fact that it usually does not fall under the umbrella of “medically necessary.”

What You Can Do

Luckily, there are solutions you can seek out in order to receive effective and reasonably priced preventative physical therapy. Perhaps the most effective is seeking out a cash-based physical therapy practice. By working with a cash-based practice, you’ll be able to circumvent the limitations of insurance altogether: you won’t have to work around maximum timelines, specific treatment guidelines that may or may not fit your needs, or in- and out-of-network physical therapists. Instead, you’ll be able to have agency along every step of your treatment by working alongside your physical therapist to create a plan that’s tailored to your unique needs. As your physical needs, capabilities, and goals change, so will your customized treatment plan.
Does health insurance affect physical therapy? The answer is yes, and in virtually every way possible. Rather than be limited by the bureaucracy of insurance, you can opt to seek out a cash-based physical therapy practice that works by your side to create effective, reasonably priced treatment plans that are completely tailored to your needs. To learn more about cash-based physical therapy, reach out to us and receive an exclusive new patient offer.
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