Hey, this is Scott with RX Rehab Physical Therapy. I’m the owner of the company and I’d like to talk about insurance and whether or not insurance covers physical therapy.
The short answer to this question is a resounding yes! Insurance does cover physical therapy benefits. There’s only been one health plan that I’ve seen in my years of practice that did not have a physical therapy benefit. I was shocked! I haven’t come across another one since then but we found out and we notified the patient before they started treatment here.
This goes to my second point if you have insurance and you’re wondering what it covers then call us and give us your information all we need is your insurance number and your date of birth and in pretty much every case we can find out for you what your insurance covers for physical therapy.
Insurance Nowadays Is Very Expensive
Premiums, which is what you pay every single month to have insurance, have gone up quite dramatically. Some people mistakenly think that because they’re paying their premium, then the insurance will automatically start paying towards their health care expenses.
Unfortunately, that’s not true. At least in most plans, that’s not true because most plans have what is called a deductible. A deductible is like an agreement you have with the insurance company.
How Do Deductibles Work
First of all, you have to pay your premium to have insurance. Then let’s say you break your leg. You go to the hospital, they take an x-ray and they do surgery on the leg. Now, what the deductible is a set amount of money that you have to pay before the insurance starts kicking in. Now some of you might think, well that sounds unfair. I’ve been paying a premium every single month and I still have to pay more before the insurance kicks in.
We know it kind of seems a little one-sided, but that’s just the way it is. So to help illustrate this a little bit more, our example of you breaking your leg, for instance. You go to the hospital and your deductible is three thousand dollars. Your insurance is Blue Cross Blue Shield and before they start paying for any medical expenses like x-rays, Dr. appointments, surgery, or even anesthesia, you have to pay your deductible. Then, once you’ve reached your deductible the insurance starts kicking in.
Now, this doesn’t mean you’re free and clear and don’t have to pay anything at that point. This is because most insurances after you’ve paid your deductible, actually say all right now we’ll start paying but we’ll pay at eighty percent and then you pay the other twenty percent. So you’re still paying a little bit towards your own health care expenses.
Using Secondary Health Insurance
If you have secondary insurance, this is when both parents, for instance, have insurance. One health insurance, let’s say from the mother, is the primary insurance. The other insurance would be secondary insurance. Let’s say someone breaks their leg in the family and the primary insurance holder has already reached their deductible. This insurance would now cover 80% and then the secondary insurance will oftentimes pick up that remaining 20%. So in those situations, people don’t have to pay anything at that point.
However, if you just have one insurance it’s typically an 80/20 split but sometimes the percentages are a little bit different. Now there’s another thing in regards to physical therapy called a copay. In some cases, with some insurances, once you’ve hit the deductible rather than having a co-insurance there’s a co-pay instead. Which is just a flat rate you’ll pay for every physical therapy visit. We’ve seen copays as little as ten dollars a visit, sometimes as much as fifty dollars a visit.
In Some Situations, It Is Better Not to Use Your Insurance for Physical Therapy
Now in some situations, this might sound a little bit crazy, but it actually makes more sense to not use your insurance. Let me explain how that works. As a clinic, we have a set amount for our cash rates which is $85 a visit. Now let’s say we have someone that comes into the clinic and they’ve got shoulder pain and they are a young person in their 20s and do not have any pre-existing conditions. There’s really no realistic chance that they won’t meet their deductible. Let’s go with the same example again of three thousand dollars. In that situation, they’ve got a hurt shoulder and have a three thousand dollar deductible before the insurance even kicks in. Chances are this is probably going to be the only time they use their insurance this year. In that situation oftentimes it makes more sense for you to not use the insurance because our cash rate, $85 a visit, is actually less than what the insurance would reimburse us if we billed the insurance.
The chances of you reaching the deductible with physical therapy are really quite small. So, in those situations often we will advise people to just pay our cash rates because if it’s a relatively minor problem even at $85 a visit chances are you’re not going to reach that deductible if we were to bill your insurance.
Looking for Physical Therapy Near Me in American Fork, Utah?
So I hope that helps. Yes, insurance does have physical therapy benefits and if you’ve reached your deductible you’ve got some aches or pains most of the time physical therapy is going to be very inexpensive. It will also be well worth your time to help get rid of your pain and get you back to doing the things you love to do.