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Unfortunately, you have some injuries or are diagnosed with illnesses that need therapy treatment. Your medical bills are constantly piling up since physical treatment does not work in one session but usually requires several ones? Is therapy covered by insurance?- You may wonder.
To your worry, we are here to confirm that there is a wide range of health insurance companies that cover physical therapy (PT). Nevertheless, in order to have your medical bills covered, you must fit the “essential benefit” criteria. Otherwise, you have to pay the full cost on your own.
Below are ways to know whether your physical therapy bills are covered by health insurance providers or not. Let’s check it out!.
Does Health Insurance Cover Therapy Cost?
It is required by the law that physical therapy and rehabilitation services be covered by ACA, also known as the Affordable Care Act under “essential benefits”.
Providing that you have a federally-qualified HMO plan from your boss, the cost of your physical therapy shall be covered, as imposed by the American Physical Therapy Association (APTA).
What’s more, some physical therapy, if categorized as preventative, could be covered by health insurance. This can be observed in the example of physical therapy preventing the elderly from falling.
However, be sure to check out carefully since in some cases, PT is not covered by non-ACA-compliant insurance and other short-term health insurance plans.
Listed below are three possible responses you are likely to hear from your insurance company for the question “Is therapy covered by insurance?”
- The PT is covered and it is your insurance company’s responsibility to pay a share of the medical bill.
- The PT is covered and you are obliged to pay a fixed fee for every visit.
- The PT isn’t covered and you have to pay the therapist whatever amount of money your insurer is able to negotiate.
Some Questions To Ask Your Health Insurance Company
In some cases, only questioning your insurer “is therapy covered by insurance” is not enough. Thus, prepping yourself with some additional questions to avoid being denied is certainly of utmost importance.
- Does your plan have any restriction on using an “in-network” therapist?
- What is the maximum of your paying out of pocket?
- Is there a limit on the number of visits allowed under my insurance plan?
- In case the patient’s medical situation requires a combination of several therapies, will the same number of visits be allowed for each?
- Are there any limitations to your therapy coverage package?
For instance, medical bills for people with developmental delays are not covered by some insurers. Another possibility is that some insurance company requires an annually-renewed referral from a physician.
Ways To Reduce Physical Therapy Costs
“Is therapy covered by insurance?” maybe right now you have the answer, but what if your therapy is not covered by health insurance providers or your coverage has certain limitations?
=> Try to examine whether you are eligible to use HSA or FSA to pay for treatment services.
For instance, “rehabilitation services” is listed in the IRS as a medical expense- part of your HSA benefits. However, in order for it to work, your therapist has to prescribe physical therapy as part of your treatment.
Moreover, the APTA recommends that viewing a physical center’s financial policy carefully before starting treatment will be of much help to avoid any further trouble.
Another tip is to negotiate a discount for multiple sessions with therapists or get information related to financing options from the hospital. Making sure to schedule physical, occupational, or speech therapy on the same day since many policies allow for any therapy in a day to count as “a visit”.
I hope after reading this article, the question “is therapy covered by insurance” will no longer baffle you that much. More often than not, diseases and injuries come unexpectedly.
You may have never thought about it and may never want to use this benefit of insurance policy’s coverage for therapy services. However, knowing some ways to maximize your coverage may prove to be helpful in the event you are working toward recovery.