With the health marketplace open enrollment approaching sooner than you think, it’s time for you to understand exactly what kinds of health care services are covered by your current health insurance plan. You also need a clear idea of what out of pocket expenses to expect and make sure that your next health insurance plan is more suitable for your needs.
Do not just re-enroll in your last year’s plan. Do some reading, dig into other offers. Even if you buy your insurance through your employer, there can be more than one option and providers to choose from, especially if you work for a large organization. Its always essential to weigh your options, even if you did last year.
Now we will talk about one often neglected aspect of your coverage, the physical therapy. Recently my wife has to take a few of those sessions, fortunately, we had it covered under our insurance, which was thrugh my employer.
Did you check if you have one covered as well?
Physical Therapy Coverage
If you’re in need of physical therapy, you will be happy to know that in general, most health insurance plans do cover such services. However, there may be rules regarding this type of coverage.
First of all, the health insurance plan covers such services only when they’re deemed “medically necessary.” This means you will need your health care provider to attest to how you really do need physical therapy.
Furthermore, in many cases, it is also required that the service is provided under the supervision and direction of a physical therapist that’s part of your insurer’s network.
If you go outside of this network to work with a physical therapist you prefer, then the insurance company will probably cover less of the cost, even if they do approve of this.
Tips on Maximizing Your Health Insurance Coverage for Physical Therapy
Not all health insurance policies offer equal benefits when it comes to physical therapy. Some are just better. However, there are actions you can take yourself which will maximize the coverage you can get from your health insurance policy:
- Be familiar with your health insurance policy. More specifically, check the details regarding the coverage for physical therapy. Know the rules and the stipulations, and make sure you check out the details in the fine print. By knowing the ins and outs of your policy, you can know exactly what your rights and responsibilities are as a policyholder.
- Pick the right physical therapist. The best ones will be in your list of carrier-approved physical therapists, if you’re lucky. If not, then you may have to go out of network, and you’ll have to determine whether the benefits of having this physical therapist help you will outweigh the greater cost for you.
A good physical therapist isn’t just one who can help with your rehabilitation. They can also help you deal with your own health insurance carrier as they have the experience with such things already.
The physical therapist can help explain all your treatment options, and they can also speak with your carrier directly if they’re hesitant to cover the physical therapy services.
- Know your physical therapy options. As a patient, you have the right to know all about your physical therapy options. You should learn about their pros and cons including how much they will cost. You are entitled to this information, and you have the right to consent to treatment only after receiving the information.
- Don’ttake a carrier’s refusal as their final word. If your carrier denies your request for physical therapy coverage, you can draft a letter that challenges their decision. It will also help if you can include letters from your primary care provider and your physical therapist why the physical therapy service is medically necessary.
- Be polite in dealing with carrier representatives. Most of the time, the people you talk to regarding the denial of your request aren’t the people who decided to deny you. So be polite with them as they can work as your allies instead of as your adversaries.
- You may consider changing policies. A new policy can be troublesome, but if you need physical therapy then you also need a policy that covers that service adequately. If your employer is paying for your insurance, talk to them as they may help. They may have a department that deals with employee insurance matters.
The good thing about health insurance is that you have options. Your best bet is to find apolicy, which offers the best coverage, including physical therapy.