Understanding Your Insurance Coverage for Physical Therapy
Does your insurance cover physical therapy services?
Many patients find themselves unsure about what their plan includes and how much they’ll need to pay out of pocket. Understanding your coverage can help you make informed decisions about your care and avoid unexpected costs.
Navigating health insurance can be complicated, but with the right knowledge, you can ensure that you receive the treatment you need without financial surprises.
GOOD NEWS: The team at Reactive Physical Therapy is here to help with any insurance questions you have and can even help you check your coverage! Call us at (435) 535-3677 (Providence) or (435) 213-9268 (North Logan) to get started!
Does My Insurance Cover Physical Therapy?
Most health insurance plans do cover physical therapy, but the extent of coverage depends on your specific plan. Coverage can vary based on factors such as:
Your insurance provider
Your specific plan's benefits
Whether your provider is in-network or out-of-network
Deductibles and copay amounts
The reason for your physical therapy (post-surgical, injury recovery, chronic condition, etc.)
If you’re in Cache Valley, UT, we can help you determine your benefits before you start treatment. Verifying your insurance coverage ahead of time can help you plan financially and avoid any unexpected expenses.
Key Physical Therapy Insurance Terms to Know
Understanding key insurance terms will help you better navigate your benefits:
Deductible – The amount you must pay out of pocket before your insurance starts covering costs. This can range from a few hundred to several thousand dollars, depending on your plan.
Copay – A fixed amount you pay for each session. Copays for physical therapy visits typically range from $20 to $50 per visit.
Coinsurance – A percentage of the cost you’re responsible for after meeting your deductible. For example, if your insurance covers 80%, you would pay the remaining 20%.
In-Network vs. Out-of-Network – Visiting an in-network provider typically lowers your costs, as insurance companies have negotiated rates with these providers.
Visit Limitations – Some plans cap the number of physical therapy visits per year. If you exceed this limit, you may need to request an extension or pay out of pocket.
How to Check Your Physical Therapy Benefits
To fully understand what your plan covers, follow these steps:
Call Your Insurance Provider – Ask about your deductible, copay, coinsurance, and visit limitations.
Verify Network Status – Ensure the clinic is in-network to maximize benefits and reduce out-of-pocket costs.
Ask About Referral Requirements – Some plans require a doctor’s referral or pre-authorization for physical therapy services.
Confirm Coverage for Specialty Services – Treatments like dry needling, deep tissue laser therapy, and blood flow restriction therapy may have different coverage rules. Some therapies may be considered elective or not covered at all.
Check for Prior Authorization – Certain insurance plans require pre-approval before beginning physical therapy. Make sure to obtain this if necessary to prevent claim denials.
What If Insurance Doesn’t Cover Everything?
Even if your insurance doesn’t fully cover physical therapy, there are still ways to make treatment affordable:
Self-Pay Discounts – Many clinics offer discounted rates for patients who pay out of pocket.
Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) – These accounts allow you to use pre-tax dollars for medical expenses, including physical therapy.
Payment Plans – Some clinics provide flexible payment options, allowing you to spread out the cost of care.
Appealing Denied Claims – If your insurance denies coverage, you may have the option to appeal the decision. Your provider can assist with submitting necessary documentation.
Making Physical Therapy Affordable in Cache Valley
We believe cost should never prevent you from getting the care you need. If you’re unsure about your benefits, we can verify your coverage and discuss payment options to make treatment accessible.
Taking proactive steps to understand your insurance benefits can help you make informed decisions about your care and ensure that you receive the necessary treatment for your condition.
Get Started Today with Physical Therapy in Cache Valley
If you need physical therapy in Providence or North Logan, we’re here to help. Call us at (435) 535-3677 (Providence) / (435) 213-9268 (North Logan) or book an appointment online. Let’s make your recovery journey simple and stress-free!