Navigating the world of insurance can be a daunting task, especially when it comes to understanding coverage for physical therapy. At Herlong Sports Physical Therapy, we aim to simplify this process for you. In this blog, we’ll cover key questions about insurance coverage for physical therapy, ensuring you feel informed and empowered.
Will Insurance Cover My Physical Therapy Treatment?
Generally, most insurance plans do provide some level of coverage for physical therapy services. However, specifics can vary widely between plans. Factors such as the type of insurance (HMO, PPO, etc.), the nature of your condition, and your provider’s network status all play a role.
To get the most accurate answer, we recommend contacting your insurance provider directly. They can provide detailed information tailored to your individual plan and needs.
Can I Get Physical Therapy Through Medicare or Medicaid?
Yes! Both Medicare and Medicaid offer coverage for physical therapy services, but there are certain conditions and limitations to keep in mind.
State of Maryland Medicare Info for Physical Therapy
Medicare typically covers physical therapy if it’s deemed medically necessary, and you will need to meet specific criteria. The basics are outlined below:
- To be seen with Medicare, our physical therapy office will require either a script from your physician OR your physician will have to sign the therapists initial evaluation and fax it back to us (the physician has to approve the plan of care created by the PT)
- Physical therapists can treat an injury for up to 90 days before needing to create a new plan of care, which must be signed again or will require a new script from your physician
- Where most insurances have visit counts/limits, Medicare has a restricted amount of money that limits the visit amount. It is possible to go over the amount, but only if it is medically necessary and justified by your physical therapist.
Medicaid varies by state, but it usually covers essential therapy services. It’s important to check with your state’s Medicaid office for specific coverage details. Our staff is also available to assist you in understanding how your benefits apply.
State of Maryland Medicaid Info for Physical Therapy
Medicaid patients can come to Herlong Sports Physical Therapy, below are the basic requirements depending on your age.
- For patients under 21: No script is needed. Visits are based on the therapist’s evaluation and determined by necessity.
- For patients 21 and older: A script or referral is required, and the number of visits is determined by insurance, based on the level of injury or deficits. Every ~30 days, we will re-evaluate and request additional visits, if necessary.
How Many Physical Therapy Visits Are Covered By Insurance?
The coverage for physical therapy visits can differ significantly based on your insurance plan. Some key points to consider include:
-
Visit Limits
Some insurance companies provide a set number of visits per calendar year, while others may limit coverage based on specific conditions.
-
Authorization Requirements
Many plans require pre-authorization for therapy services. This means that after your initial appointment, our physical therapist will submit a note and a plan of care to your insurance company. They will then determine how many visits are necessary for your recovery.
When you start treatment with us, our billing administrator will verify your insurance, helping you understand your specific coverage and any requirements.
What Should I Do if I Have Questions About Coverage, Fees, Co-pays, etc.?
If you have questions about your coverage, fees, co-pays, or deductibles, the best approach is to call your insurance company directly. Know that our team at Herlong Sports Physical Therapy is here to support you and our front desk staff will verify your insurance prior to your appointment, but your insurance company may have more information for you depending on the nature of your question(s).
Additionally, please remember that we do not set your co-insurance, co-pay, or deductible amounts – these are established by your insurance provider when you select your plan.
Can I Get Physical Therapy Through Direct Access?
Absolutely! Maryland is a direct access state, which means you can receive physical therapy without needing a physician’s referral through most insurance plans. This allows you to start your therapy sooner, which can be crucial for your recovery. If you’re unsure about how direct access works, our team can guide you through the process.
Physical Therapy Covered By Insurance in Maryland
In Maryland, physical therapy services are typically covered by insurance, including private plans, Medicare, and Medicaid. It’s essential to understand the specific terms of your plan, including any limitations or requirements. Our knowledgeable staff at Herlong Sports Physical Therapy is here to assist you with any questions regarding your insurance coverage and help you maximize your benefits.