Insurance Coverage for Physical Therapy: What You Need to Know

Insurance Coverage for Physical Therapy: What You Need to Know

If you are in need of physical therapy, it is important to know what your insurance policy covers. Many people are surprised to find out that physical therapy is not always a covered benefit. In this blog post, we will discuss the different types of insurance policies and what coverage they provide for physical therapy. We will also provide tips on how to get the most out of your insurance benefits.

What Is Physical Therapy?

What Is Physical Therapy?

Physical therapy (PT) is a type of medical treatment that helps patients regain movement and function after an injury or illness. It can be used to treat a wide range of conditions, including back pain, arthritis, stroke, and cerebral palsy.

PT involves a variety of exercises and therapies designed to stretch and strengthen muscles, improve range of motion, and reduce pain. PT can be performed in a hospital, clinic, or outpatient setting.

Is Physical Therapy Covered By Insurance?

Yes, physical therapy is covered by insurance. However, the amount of coverage and the type of physical therapy services that are covered may vary depending on your individual insurance plan.

  • If you have questions about your specific insurance coverage for physical therapy, please contact your insurance provider directly. For instance, if you are wondering about your copayment or deductible for physical therapy services, your insurance company will be able to give you this information. In general, most insurance plans will cover at least a portion of the cost of physical therapy services. However, there may be some cases in which physical therapy is not covered by insurance.
  • Even if your insurance plan does not cover the full cost of physical therapy services, you may still be able to receive some financial assistance. Many physical therapy clinics offer sliding scale fees or discounts for patients who are unable to pay the full cost of services. If you are concerned about your ability to pay for physical therapy, be sure to discuss your concerns with your physical therapist or the staff at your physical therapy clinic.

It is important to remember that insurance coverage for physical therapy may change over time. Be sure to keep up-to-date on your insurance plan’s coverage for physical therapy services. If you have any questions, please contact your insurance provider or physical therapist for more information.

Why Do People Need Insurance For Physical Therapy?

Physical therapy is often necessary following an injury or surgery. It can also be used to manage pain or improve movement and function in people with chronic conditions such as arthritis, multiple sclerosis, or Parkinson’s disease.

While the cost of physical therapy can vary depending on the type and intensity of services required, it is generally not cheap. That’s why most people rely on insurance to help cover the cost of physical therapy.

However, there can be confusion about what type of insurance coverage is available for physical therapy. In this article, we will explore the different types of insurance that can be used to cover physical therapy and what you need to know before seeking treatment.

What Are The Different Types of Insurance Policies?

In general, most insurance policies will cover physical therapy as long as it is considered medically necessary.

Physical therapy is often prescribed by a physician in order to treat a wide variety of conditions, so it is typically considered to be medically necessary. However, there are some instances where insurance companies may not cover physical therapy. For example, if physical therapy is being used for preventative purposes or for cosmetic reasons, it is unlikely that insurance will cover the cost.

The different types of insurance policies are as follows:

Health Maintenance Organization (HMO)

An HMO plan is a type of managed care plan. This means that the insurance company will work with a group of doctors, hospitals, and other healthcare providers to provide care for policyholders. In order to see a specialist, like a physical therapist, you will need to get a referral from your primary care doctor

Preferred Provider Organization (PPO)

A PPO plan is also a type of managed care plan. However, with a PPO plan, policyholders have more flexibility in terms of choosing their doctors and other healthcare providers. You do not need a referral from your primary care doctor to see a specialist like a physical therapist.

Point of Service (POS)

A POS plan is a type of managed care plan that combines features of both HMO and PPO plans. With a POS plan, you will need to get a referral from your primary care doctor in order to see a specialist. However, you also have the option of seeing out-of-network providers, although you will likely pay more for doing so.

High Deductible Health Plan (HDHP)

An HDHP is a type of health insurance plan that has a high deductible, meaning that you will have to pay more out-of-pocket costs before your insurance company starts to pay for your care. However, HDHPs typically have lower monthly premiums than other types of health insurance plans.

Health Savings Account (HSA)

It is a type of savings account that can be used to pay for medical expenses. HSAs are only available for people who have an HDHP. For instance, if you have an HSA-qualified health plan, your insurance company may offer an HSA to help you pay for out-of-pocket medical expenses.

Exclusive Provider Organization (EPO)

An EPO is a type of managed care plan that contracts with a specific group of doctors and hospitals to provide care for its members. EPOs usually do not require members to get a referral from a primary care doctor before seeing a specialist.

Fee for Service or Indemnity Plans

Original Medicare (Parts A and B) does not cover outpatient physical therapy. If you have a private Fee-for-Service (FFS) plan or an Indemnity plan, check with your insurance company to see if it will cover outpatient physical therapy. Some companies may require that you get a referral from your doctor before they will cover the cost of physical therapy.

The out-of-pocket costs for physical therapy can vary depending on the type of insurance policy that you have. If you have an HMO or POS policy, you will likely have to pay a co-pay for each physical therapy session.

Can Someone be denied physical therapy through insurance?

Can Someone be denied physical therapy through insurance?

The answer is maybe. If you have a physical therapy plan through your insurance, they may limit how many visits you can make or what types of services you can receive. Your physical therapist can work with you to understand your insurance benefits and coverage. Filing an insurance claim for physical therapy can be confusing and time-consuming. Your physical therapist can help you understand your benefits and file the necessary paperwork to get reimbursement for your visits.

There are a few reasons why your insurance company may deny coverage for physical therapy.

  • The most common reason is that they don’t consider it medically necessary. They may also not cover physical therapy if they feel you can get the same results from other cheaper treatments.
  • If your insurance company denies coverage for physical therapy, you have a few options. You can appeal the decision with your insurance company.
  • You can also pay for physical therapy out-of-pocket. Some physical therapists offer sliding scale fees or payment plans to make treatment more affordable.

If you’re considering physical therapy, be sure to check with your insurance company first to understand your coverage and benefits. Your physical therapist can also help you navigate the insurance claims process.

Tips To Get Your Insurance Benefits

There are various tips:

Know what your insurance policy covers

It is important that you first know what your insurance policy covers. This way, you will have a good idea as to how much coverage you can expect from your insurer. To do this, simply give them a call or check their website to find out the details of your policy.

Choose an in-network provider

If you want to make sure that your insurance benefits will be maximized, then it is best to choose an in-network provider. This means that the physical therapist you select is part of your insurer’s network of approved providers. As such, they will likely offer you lower rates than if you went to an out-of-network provider.

Get a referral from your doctor

In some cases, your doctor may need to provide a referral in order for you to get coverage from your insurance company. Therefore, it is important to check with your doctor beforehand to see if this is something that you will need.

Inquire about pre-authorization

If your insurance company requires pre-authorization for physical therapy, then be sure to inquire about this before you begin treatment. This way, you can avoid any issues down the road and be sure that your treatments will be covered by your insurer.

Keep track of your expenses

Lastly, it is important to keep track of all of your expenses related to physical therapy. This includes things like co-pays, deductibles, and any other out-of-pocket costs. This way, you can submit these expenses to your insurance company for reimbursement.

By following these tips, you can be sure that you will get the most out of your insurance benefits when it comes to physical therapy.


It may be concluded that “Is physical therapy covered by insurance” is a difficult question to answer. Every insurance company is different, and what may be covered by one company may not be covered by another. It is advisable to speak with your insurance company directly in order to determine whether or not physical therapy will be covered under your policy.

Physical Therapy help patients recover from pain. If you’re experiencing Back pain, Shoulder pain, Knee pain, Neck pain, Elbow pain, Hip pain, or Arthritis pain, a physical therapist at MantraCare can help: Book a physiotherapy session.

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