Nobody wants to be hit with an unexpected medical bill, but figuring out health insurance coverage can be a complex process. You’ll probably look to clear up some coverage questions prior to an elective surgery, but what about life after your operation? Will certain aspects of your rehabilitation like physical therapy also be covered by insurance, or should you start budgeting to pay for these services out of pocket? We take a closer look at health insurance coverage for physical therapy services after surgery in today’s blog.
Will Insurance Cover PT After Surgery?
It should go without saying, but we just want to cover our bases here and say that we cannot speak for all individuals or providers when it comes to health insurance. We do everything in our power to help ensure coverage and prevent any financial surprises from our services, but for the most accurate understanding of your coverage, you’ll want to speak directly to your policy provider. The following is general information based on our position in the industry and our experience helping customers understand their coverage options when it comes to physical therapy after surgery.
In most instances, your health insurance provider will offer partial or full coverage for physical therapy services that you receive following your surgical operation. Most health insurance companies cover the cost of medical expenses that are deemed a medical necessity. Because physical therapy is a standard treatment to help a patient make a full recovery following a surgical procedure, PT is considered a medical necessity. Again, it may warrant a conversation with your insurance provider, but if your surgeon, your family practitioner or even a physical therapist (Minnesota is a direct access state when it comes to physical therapy services) decides that physical therapy services are medically necessary for the patient, your health insurance policy would likely cover most or all of the cost of your appointments.
Although the definition of “medically necessary” may be viewed a little differently by interested parties, Medicare considers physical therapy services to be medically necessary if they are:
- Safe and effective;
- Have a duration and frequency that are appropriate based on standard practices for the diagnosis and treatment;
- Meet the medical needs of the patient; and
- Require a therapist’s skill.
Oftentimes you’ll need weeks or months of physical therapy following a surgical procedure in order to make the fullest recovery, and these sessions should continue to be covered unless certain conditions arise. Two common conditions that may lead to the termination of coverage for physical therapy sessions include:
- You’ve reached your maximum recovery and your doctor or PT no longer feel that sessions are medically necessary.
- You miss multiple sessions.
Physical therapy services are designed to help you make the strongest recovery, and if you’ve achieved that with the first scenario, you no longer need to continue PT sessions. As to the second point, if you are regularly missing appointments and jeopardizing your recovery, your insurance company may attempt to deny your claim, as they are not going to pay for services to help you heal if you aren’t going to do the bare minimum and show up as expected. We understand that things come up last minute, but if it becomes a pattern, the insurance company may push back against your claim.
For more information about how you can better understand your health insurance coverage as it pertains to physical therapy both before and after an operation, reach out to the team at OrthoRehab Specialists today at (612) 339-2041.
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