• Understanding Payment for Physical Therapy Services

    Are You Covered?

    Physical therapists are professional health care providers who are licensed by the state in which they practice. You can check with your state agency overseeing physical therapy licensure to make sure that your physical therapist is licensed and in good standing or with the state's physical therapy chapter. The following are common questions and answers pertaining to payment and insurance for physical therapy services.

    Does insurance cover physical therapy services?

    Most insurance plans, including Medicare, workers’ compensation, and private insurers, pay for physical therapy services that are medically necessary and that are provided by or under the direction and supervision of a physical therapist.  Your physical therapist or your insurance company can tell you whether your insurance covers the recommended services and how much your out of pocket costs will be if there are any.

    What if your physical therapist doesn’t participate in your insurance plan?

    Most insurance companies, with the exception of Medicare and many HMOs, allow members to go "out of network" for health care services.  Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. In most cases, the amount paid by the insurance company will be less, and you will be responsible for paying the difference between what the physical therapist charges and what the insurance company pays. Many patients choose to receive services out of network in order to see the physical therapist of their choice.  Your physical therapist can let you know in advance of your treatment what your out of pocket costs will be.

    What if you don’t have insurance?

    If you don't have health insurance that covers physical therapy services, you can still receive services from a physical therapist by paying for the services directly.   If cost is a barrier, you may want to ask your physical therapist to modify your program so that you can do more of your treatment on your own.  Ask about establishing a payment plan so that you can get the care that you need when you need it most.

    Are there some services that physical therapists provide that are not covered by insurance?

    Some physical therapists provide services that may not be covered by insurance plans. Examples of these services include fitness and wellness programs, sports performance enhancement, health education classes, and some prevention programs. Many individuals find these services to be of tremendous value and readily pay out of pocket for them.  Your physical therapist can let you know whether these services are covered by your insurance and can give you information about their costs in advance.

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