Insurance

You may wonder if you have insurance that covers physical therapy. Coverage for physical therapy is as different as the insurance plans themselves.

The good news is that most insurance companies now cover some part of physical therapy, although they may put limitations on which physical therapist you can see, based on whether they are in network physical therapists or out of network providers.

Additionally, in the state of California, you can start physical therapy without a doctor’s referral. However, some insurance companies will first want your doctor’s authorization to reimburse for physical therapy services, so it’s worth a phone call to your health insurance plan before you begin seeing your physical therapist.

Total costs will depend upon the nature of the injury and treatment and the duration of the session.

While the out-of-pocket costs may seem like a big investment, many people find that investing in physical therapy can ultimately save money in the long run. Services provided by licensed physical therapists, like those at Live Life Physiotherapy, go beyond the prescription of routine exercises and often include lifestyle improvements and encouragement that are essential to your recovery and can empower you to lead a healthier, more active lifestyle.

Medicare is an insurance program administered by the federal government that provides coverage for people who are at least 65.

If you’re a Medicare patient, you’ll need a certification from your doctor or other health care provider, such as a physician assistant, nurse practitioner, or clinical nurse specialist, to begin physical therapy. Once you have that certification, Medicare Part B (the medical insurance part of the insurance plan) will kick in and help cover physical therapy.

At this point, you’ll be able to meet with your physical therapist and begin your physical therapy treatment plan.

There’s no limit on how much Medicare pays for your physical therapy services each year, as long as they are deemed medically necessary. And looking to the future, the American Physical Therapy Association is active in lobbying Congress to ensure Medicare continues covering services like physical therapy.

After you meet the Part B Deductible, you pay 20% of the Medicare-approved amount. For 2023, that means that you pay $226 to meet your Part B deductible. After meeting this deductible, you will pay 20% of the Medicare-approved amount for the Medicare-negotiated rate for your continued physical therapy sessions. (Source: Medicare.gov)

Before you begin physical therapy, you’ll want to really dive deep into your insurance plan to understand your total out of pocket cost and what medical expenses your insurance covers.

If you have a high deductible—meaning that you have to pay a lot of money before your insurance plan kicks in—you may save money by opting for self pay and paying a negotiated rate from the very beginning.

However, if you have an out of pocket maximum—meaning that your out of pocket cost will not exceed a certain amount, at which point your insurance coverage covers your physical therapy—you may benefit by letting your insurance pay.

Some physical therapy services may not be covered by insurance. These usually involve a wide variety of health care services, such as general health education, fitness programs, or a custom home exercise program. Some of these services also include preventive activities and athletic enhancements.

Additionally, some insurance plans cover only a minimum number of physiotherapy visits. If that’s the case, the physical therapists at Live Life Physiotherapy will find a way to continue working with you until you decide you’re ready to graduate from physical therapy.

From our perspective at Live Life Physiotherapy, we will work with you as long as you like. We do not place limits on how many times you can see a physical therapist.

However, some insurance plans may cover fewer sessions than you would like to receive. If you’d like to continue seeing your physical therapist, but your insurance provider has limited how many rehabilitation services you can receive, just let us know. We are happy to work with you to come up with a payment plan that allows you to continue your physical therapy sessions.

Yes, physical therapy sessions are eligible for reimbursement in the form of a Flexible Spending Account (FSA).

Yes, physical therapy is eligible to be paid through your Health Savings Account (HSA).