Many people seek physical therapy to treat a wide variety of muscle and joint ailments. Unfortunately, the rules about health insurance for this type of medical care are complex. The guide below explains how health care coverage can vary depending on the type of insurance policy and plan you have.

What to Know About Health Insurance & Physical Therapy

How Employee-Sponsored Insurance Works

Most Americans who have health insurance get it through their job, and the majority of these policies cover sessions that are deemed medically necessary. People who have this type of insurance generally don’t have to pay for service, at least up to a point. For example, physical therapy for rehabilitation may be considered an essential health benefit (EHB) under the Affordable Care Act, but health insurance plans can place limits on the number and frequency of treatment sessions they’ll cover.

How Other Types of Insurance Plans Provide

Medicare part B covers physical therapy if the services are performed on an outpatient basis, but it caps how much of this treatment it will cover. Patients can sometimes obtain an exception to this maximum if their provider can prove that treatment is medically reasonable and necessary. Unlike Medicare, which is managed by the federal government, Medicaid is managed at the state level, so benefits vary from state to state. Health insurance plans sold by the federal marketplace and state exchanges have to offer benefits comparable to a typical job-sponsored health plan.

When Physical Therapy Isn’t Covered

Some physical therapists offer services that usually aren’t covered by insurance, such as fitness programs that help with pain relief. Patients who wish to receive services that aren’t covered by insurance, or who have reached their limit on benefits, may have the option of working out a payment plan with their health care provider to make the out-of-pocket costs for these treatments more affordable. In some cases, the physical therapist may be able to suggest a modified treatment plan for the patient to follow at home. 

O’Fallon Pain Relief Associates in St. Charles County, MO, offers a comprehensive approach to pain management. Whether you’re seeking physical therapy or the services of a chiropractor, their caring, experienced team is dedicated to treating the cause of your pain, not just the symptoms. Call (636) 978-3000 to request an appointment, or visit their website to learn more about their wide range of services.