Is physical therapy covered by insurance? Everything you need to know about what your insurance allows and limits when it comes to physical therapy.

by | May 14, 2021 | Sports Injuries

Is physical therapy covered by insurance? The short answer is yes – and sometimes no. The extent to which your insurance company will cover your physical therapy treatment depends on a variety of factors, including obvious ones like your provider and plan. Factors also include the type of physical therapy treatment you’re looking to receive and the amount of time for which you’re looking to receive it. Ultimately, insurance can be a good way to get the cost of treatment covered after an accident or trauma. Beyond that, however, is where coverage can become a little more difficult. Today, we’re going over what you can generally expect out of your coverage for physical therapy. Let’s get started.

What’s Covered and What’s Limited

The majority of insurance providers cover physical therapy that is considered “medically necessary.” For insurance companies, “medically necessary” procedures are the ones that must be done in order to diagnose or treat an injury or illness. For example, medically “necessary” physical therapy for insurance purposes includes rehabilitation after a serious injury or trauma. Even for treatments that are deemed medically necessary, there is often a cost cap for what insurance companies will cover. The exact amount of that cap varies based on your plan and provider (Medicare, for instance, caps physical therapy coverage at $1,920). However, if you are looking for long-term physical therapy (or treatment for an indefinite amount of time), it is highly likely you will face insurance limitations regardless of how medically “necessary” the treatment is deemed.

Generally speaking, preventive physical therapy is not covered by insurance. Physical therapy that addresses an old injury or pain may or may not be covered (or partially covered) depending on your insurance provider. In any case, going through an insurance provider to receive physical therapy treatment – regardless of the treatment’s alleged necessity level – means having to go through quite a bit of hoops. It also might mean having to prepare yourself to front a lot of the costs anyway, depending on your insurance provider’s coverage cap.

Preventive Physical Therapy Explained

What purpose does preventive physical therapy serve, and why is it notable that insurance companies usually don’t cover it? Physical therapy is often viewed as a rehabilitative form of treatment, usually not seeked out by patients unless it’s in reaction to an injury or pain. However, this isn’t the only application of physical therapy; that’s where preventive PT comes in. Preventive physical therapy takes a look at your unique physiological characteristics, activity levels, and lifestyle habits in order to prevent injury or pain down the line. It works to improve flexibility, maximize mobility, and grow muscular strength. Preventive physical therapy is an extremely effective and useful tool for preventing serious and potentially fatal afflictions, including heart disease, osteoporosis, arthritis, obesity, high blood pressure. It can also help to significantly reduce the risk of serious injury from physical activity or a fall.

It’s a big deal that preventive physical therapy isn’t covered by insurance, because this lack of coverage (or severely restricted coverage) can prevent individuals from receiving potentially life-saving or life-altering care due to bureaucratic restrictions.

What You Can Do

The best thing you can do is stay informed. Look into your insurance provider’s specific guidelines and restrictions when it comes to physical therapy. If you have an injury, pain, or physical goal that you’d like to address and find that it is not covered by insurance, look into your options. Your physical health is the single most important resource you have, and there are plenty of cash-based physical therapy providers – Purpose Physical Therapy and Wellness included – that offer individualized plans without the constraints of insurance.
Is physical therapy covered by insurance? Can be a more complicated question than meets the eye, but the answer that matters most is simple: no matter what kind of care you’re seeking, there are great options available to you. To learn more about your cash-based physical therapy options, feel free to contact us.
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