Is Physical Therapy Covered Under Health Insurance?

Whether you have recently been injured or you are experiencing chronic pain or limited mobility, going to a physical therapist can greatly improve your quality of life. For many people, concerns about how much regular sessions cost is a big roadblock to getting much needed care. Fortunately, if you have an ACA-compliant health insurance plan, rehabilitative services like physical therapy are listed among the essential health benefits. Your health insurance agent can help you understand your specific policy, so you know what to expect if you need physical therapy.

Do I Need a Referral to See a Physical Therapist?

Whether you need a referral to see a physical therapist depends on your health insurance plan. Generally speaking, if you have an HMO plan, you need a referral from your primary doctor to see a specialist, such as a physical therapist. If you have a PPO, you do not need a referral to see a specialist. However, it is important to note that even if your health insurance plan does not require that you get a referral to see a physical therapist, the therapist may require a referral from your doctor. Also, give your health insurance plan a call and inform them of your need for rehab and find out if you need and pre-authorizations.

Are Physical Therapy Sessions Covered by My Health Insurance?

If you have health insurance through your employer, you purchased your policy through Nevada Health Link, or if your plan was purchased “Off Exchange” (not purchased through Nevada Health Link) but is still an ACA (Obamacare) plan, then your plan is ACA-compliant and covers physical therapy for new or old injuries. Be aware that you’ll have deductibles, co-insurance, and co-pays most likely. You’ll need to ask your broker/agent or your health insurance company how your plan works. Therefore, it’s so important to have an agent you can ask these types of questions to and get quick answers.

It is also important to note that your health insurance may only covers a certain number of sessions, regardless of how many sessions you need. Your doctor may want you to attend 60 physical therapy sessions, but your health insurance may only cover 36 of those sessions. Again, ask your agent or health insurance plan.​

In addition to your health insurance, there may be a few other avenues for covering the cost of physical therapy, depending on your situation. If you need physical therapy to recover from an injury in a car accident that you are not liable for, then the other driver’s liability auto insurance should cover your medical bills. If you were injured at work, you may be entitled to worker’s compensation, or if you were injured while you were on active duty for the military, there may be government programs that cover physical therapy.

Finding Physical Therapy Coverage with Nevada Insurance Enrollment

Physical therapy can be expensive, but by knowing how much your health insurance covers and how much you must pay out of pocket, you and your doctor can come up with an affordable care plan. At Nevada Insurance Enrollment, our health insurance agents can help you understand your coverage or find a health insurance plan that meets your needs.