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Physical therapy is the treatment of an injury, deformity, or disease by methods such as massage and targeted exercise. The aim of physical therapy is to relieve pain, increase mobility, and strengthen weakened muscles. A patient may need physical therapy to help
manage pain or restore mobility after surgery or an injury or if they cannot perform daily activities that they have been able to do in the past. The cost of physical therapy varies and depends largely on whether or not the patient has health insurance. Physical therapy will
usually be covered by insurance, many times in full, but at least in part.

Insurance plans, including Medicare, private insurance, and workers’ compensation will usually pay for “medically necessary” physical therapy services. To find out if insurance will cover PT services, a healthcare professional may need to confirm that physical therapy
is medically necessary. It is important to note that many insurance companies do not always use the same definition of medical necessity, but in general, medically necessary means that physical therapy treatment:

  • meets a medical and functional need
  • aligns with the general standards of healthcare

It is important for the patient to review their insurance policy fully to determine the extent of their coverage. Knowing exactly what the policy covers gives the patient an advantage when seeking PT treatment. Sometimes it is important to contact the insurance provider
directly to learn of any limitations as well as the steps needed in accessing services.

Direct access physical therapy refers to the ability of patients to seek and receive physical therapy services without first obtaining a referral from a physician. This approach allows individuals to directly connect with a physical therapist, promoting quicker access to care
and timely intervention for musculoskeletal issues, injuries, or movement-related concerns.

Some insurance companies may request their clients provide a doctor’s referral or care plan; however, thanks to direct access, you can receive PT care by contacting a physical therapist directly.

At times, an insurance company may only cover physical therapy services if it is provided by in-network therapists or facilities. If a physical therapist is out-of-network, they often have different coverage rates or treatment may not be covered.

Additional Questions to Ask:

  • Is Pre-Authorization Required?
  • Are There Session Limits?
  • Will I Have a Copay or Deductible?

Your physical therapist can be a great ally in maximizing treatment coverage. At ACE PT, we have an ample amount of experience working with insurance companies and we will work to advocate on your behalf. Reach out to the experts at ACE Physical Therapy for a consultation today!

ACE Physical Therapy and Sports Medicine Institute was founded on the principles of high ethical standards, integrity, honesty, and professionalism. When you step inside one of their eight convenient locations in the Washington Metro area, your goal becomes theirs: returning you to your normal lifestyle as quickly and safely as possible.

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