Physical therapy is a vital part of recovery for many, whether you’re bouncing back from an injury, recovering from surgery, dealing with chronic pain, or trying to improve mobility. Understanding the costs associated with physical therapy and how insurance coverage works can make a significant difference in managing your healthcare. With this guide, you’ll learn what you can expect when it comes to paying for physical therapy and how to navigate the often complex waters of insurance coverage.
What Does Physical Therapy Cost?
There are a few factors that determine the cost of physical therapy. Costs can vary widely depending on location, the severity of the treated issue, and the type of therapy required. Not to mention, every treatment plan is unique to suit the needs of every patient. Below are some key points to consider when determining affordable pricing for your physical therapy treatment.
Types of Therapy
Physical therapy can address a wide range of issues, including specific conditions such as chronic shoulder pain and back pain. Each type of therapy is tailored to the unique needs of the condition being treated and your goals. Each type also has different pricing structures to match the processes and equipment used by physical therapists for provided programs.
Here are some common physical therapy services:
- Orthopedic Physical Therapy: Treats conditions such as arthritis, back pain, fractures, sprains, and post-operative injuries. Back pain physical therapy is a common form of orthopedic physical therapy.
- Geriatric Physical Therapy: Designed for older adults, it helps alleviate pain and increase mobility associated with conditions such as osteoporosis, arthritis, Alzheimer’s disease, hip and joint replacement, balance disorders, and incontinence. Hip injury treatment is a common example.
- Neurological Physical Therapy: This specialty is for individuals with neurological disorders or diseases such as Parkinson’s disease, multiple sclerosis, and vestibular dysfunction. It also helps those who have experienced a stroke, spinal cord injury, or any traumatic brain injury. Stroke rehab can help those recover from some forms of brain damage after surviving a stroke.
- Cardiac Rehabilitation: This specialty helps patients with cardiopulmonary conditions and post-surgical patients.
- Comprehensive Injury Therapy: Injuries such as rotator cuff tears, brain injuries, and ACL tears are a few types of injuries treated with physical therapy. However, injury treatment encompasses a wide range of specialty therapies for injuries and traumas that require physical therapy to improve or manage.
- Women’s Health Physical Therapy: This specialty addresses women’s health issues and includes therapies such as pelvic floor physical therapy.
Physical Therapy Sessions: Length and Visit Frequency
Costs can also vary according to the length of treatment sessions and the number of sessions you attend. Typically, a physical therapy session lasts 30 to 60 minutes, but the length can vary according to your care plan. Moreover, the first visit is usually longer to discuss your medical history and condition and tailor your physical therapy program to your current abilities and goals.
Provider Variations
Costs differ significantly between providers. Hospitals or specialty physical therapy clinics sometimes charge more than private physical therapy offices.
Geographic Location
Like many other services, the cost of physical therapy can vary depending on where you live. Urban areas might have higher rates than rural areas due to higher operational costs.
Insurance Coverage for Physical Therapy
Insurance can play a large role in how much you actually pay out-of-pocket for physical therapy. Here’s what you need to know about navigating insurance.
Understanding Your Policy
It’s crucial to understand what your insurance covers. Some policies may cover physical therapy entirely, while others may require a copay or cap the number of sessions or the deductible amount you must pay out of pocket before your health insurance covers the rest.
In-Network vs. Out-of-Network
Always check whether the physical therapist is in-network, which means they have a contract with your insurance company offering specific rates. Out-of-network therapists may result in higher out-of-pocket costs.
While most patients try to avoid paying out of pocket, sometimes, it’s the only way to receive the quality care they need. In the next section, we will offer some tips on navigating those situations.
Pre-Authorization
Some insurance plans require pre-authorization for physical therapy. This means you need approval from your insurance provider before starting treatment from any physical therapy clinic to ensure coverage.
Deductibles and Out-of-Pocket Maximums
Know your deductible — the amount you pay before your insurance starts paying — as well as your out-of-pocket maximum, which is the most you’ll pay in a policy period.
Strategies to Manage Costs
Here are a few strategies that can help manage the costs associated with physical therapy.
Discuss Payment Options
Talk with your physical therapy provider about payment plans or sliding scale options, which can help make the treatment more affordable.
Utilize a Health Savings Account (HSA) or Flexible Spending Account (FSA)
If you have an HSA or FSA, you can use it to pay for physical therapy with pre-tax dollars. Health Savings Accounts and Flexible Spending Accounts are both types of tax-advantaged accounts that allow individuals to save money for medical expenses.
Seek Outpatient Clinics
Inpatient physical therapy services are typically more intensive, with therapies conducted multiple times a day, often as part of a broader rehabilitation program. This is usually required after a significant surgery, injury, or illness.
Due to the intensive nature and the healthcare setting, inpatient therapy can be more expensive than outpatient therapy. However, insurance often covers it under specific criteria like medical necessity.
Outpatient physical therapy appointments are less intensive compared to inpatient therapy. Patients typically visit the clinic for sessions ranging from 30 minutes to an hour, usually a few times a week.
It’s generally less expensive than inpatient therapy and is often also covered by insurance, but insurance coverage specifics, like the number of sessions and types of therapy covered, can vary.
Regular Reviews
Review your progress regularly with your therapist to ensure that all prescribed therapy remains necessary. This can help avoid unnecessary sessions. Many patients can complete their physical therapy programs if they adhere to their program and show up to scheduled appointments.
Contact BioMotion Physical Therapy to Determine Your Physical Therapy Cost
Navigating the costs and coverage of physical therapy can seem daunting at first, but understanding these aspects can significantly reduce stress and help you focus on what truly matters: your recovery. If you’re unsure about any part of the insurance process, please contact us at BioMotion Physical Therapy to learn more about physical therapy costs and coverage at our practice. We’ll even provide you with a free screening!
