If you’ve been referred to physical therapy by your doctor, one of your first questions may be:
“Will my insurance cover physical therapy?”
The short answer is yes, most insurance plans include benefits for physical therapy services. However, the amount of coverage depends on your specific insurance plan, your deductible, and whether your provider is in-network.
Our offices are in-network with most major commercial insurance plans.
Below are some of the most common questions we receive from new patients searching for a physical therapy office.
Is Your Office In-Network With My Insurance?
We accept most commercial insurance plans, Medicare, and Workers’ Compensation plans.
Before scheduling your first appointment, our staff will verify your insurance benefits so you fully understand:
- Your estimated cost per visit
- Your deductible status
- Copays or coinsurance
- Visit limitations or authorization requirements
At our office, we believe in being as transparent as possible when it comes to billing and insurance coverage so there are no surprises during your treatment.
How Much Will I Have to Pay Per Visit?
The cost of each physical therapy visit depends on your insurance plan.
Some insurance plans cover a large portion of the visit cost, while others require patients to pay more out of pocket. Every plan is different.
You may have:
- A copay
- A deductible
- Coinsurance
- An out-of-pocket maximum
Copay
A copay is a fixed amount you pay per visit, determined by your insurance company.
You will continue paying this amount until you reach your annual out-of-pocket maximum.
Deductible
If your plan includes a deductible, you may be responsible for paying the contracted insurance rate until your deductible is met.
Once your deductible has been satisfied, insurance will begin sharing the cost through coinsurance.
Coinsurance
Coinsurance is the percentage of the visit cost that you are responsible for after meeting your deductible.
Most coinsurance amounts range between 10%–30% of the contracted rate.
Out-of-Pocket Maximum
Your out-of-pocket maximum is the highest amount your insurance requires you to pay during the year.
Once you reach this limit through copays, deductibles, and coinsurance payments, your insurance may begin covering 100% of approved visits.
How Many Physical Therapy Visits Will I Need?
The number of physical therapy visits you may need depends on several factors, including:
- Your injury or condition
- Your doctor’s recommendations
- Whether you recently had surgery
- Your physical therapist’s evaluation
- Your insurance coverage and visit limits
Some insurance plans limit the number of therapy visits allowed each year, while others require authorizations.
What Are Authorizations?
Authorizations are requests submitted by the physical therapy office asking the insurance company to approve a certain number of visits.
Insurance companies review:
- Your evaluation
- Progress notes
- Functional improvement
- Medical necessity
Additional visits may be denied if:
- Progress is not being made
- Symptoms are worsening
- The insurance company believes you can continue independently with a home exercise program
Our office tracks your approved visits and remaining benefits to help prevent unexpected charges.
Rahabilitation is Our Goal
Our goal is to help patients recover, improve function, and return to normal activities safely and efficiently.
Physical therapy is designed to help you become independent, not to keep you in treatment forever.
Have Questions About Your Insurance Benefits?
Our office staff is experienced in understanding insurance coverage and physical therapy benefits.
If you have questions about your insurance plan or coverage for physical therapy, give our office a call. We are happy to verify your benefits and help explain your coverage before your first appointment.
