Insurance Coverage for Physical Therapy

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.

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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.

Are Physical Therapy Sessions Covered by My Health Insurance?

If you have health insurance through your employer or you purchased your policy through Nevada Health Link, or was purchased “Off Exchange” but is still an ACA 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 how your plan works.  This is why it’s so important to have an agent you can ask these type of question to.

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It is also important to note that your health insurance probably 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.

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 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 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.

Related Articles:

What Is The Difference Between An HMO And A PPO?

Health Insurance in Nevada: On Exchange vs. Off Exchange

What Are Essential Health Benefits and Who Has to Have Them?

What Is Covered by The Affordable Care Act (ACA) Health Care Plans

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