Physical therapy is one of the most effective ways to treat injuries and long-term movement disorders. Physical therapy insurance is often a gray area for many insurance companies, but there are steps you can take to maximize insurance coverage. You should also consider all options as you can get inpatient or outpatient rehab care; some would also argue that chiropractic is better than physiotherapy for joint treatment. This guide will cover the basic strategies you can use to get better physical therapy insurance coverage.
1) Review Your Policy
Insurance coverage for physical therapy tends to come with stacks of paperwork. It can be overwhelming to review all the documents associated with your insurance, but studying these materials is essential if you want to maximize insurance coverage. Almost all insurance companies offer coverage for physical therapy, but that coverage is subject to certain rules and stipulations that may only show up in the fine print. Knowing the ins and outs of your insurance policy can give you an edge when it comes to trying to get your insurance company to pay for these much-needed services. Just because something is covered in your policy does not mean that you won’t run into problems getting the insurance company to pay for it. Knowing your rights and responsibilities as an insurance holder is the first step to maximizing your coverage.
2) Be Proactive
In addition to knowing your rights as an insurance policy holder, you should also make an effort to know your rights as a physical therapy patient. Get to know the policies and procedures of your physical therapy center and find out how and what it charges for services. As a patient, you have the right to consent to treatment and receive thorough information about all physical therapy options being presented to you. Knowing how and why you need various physical therapy services will be handy if you have to argue with your insurance company to receive the coverage for physical therapy you deserve. Too many patients take a passive role in their medical care and forget that they have the right to an active say in their own care. If your physical therapist refuses to give you the information you are entitled to, it may be time to find another facility.
3) Know Your Physical Therapist
Consider your physical therapist your primary ally when it comes time to maximize insurance coverage. This means it’s very important to choose the right physical therapist. As health care providers, physical therapists have plenty of experience dealing with insurance companies. Your therapist has likely helped many patients maximize insurance coverage, so don’t be afraid to ask them for assistance in obtaining the insurance coverage you deserve. Physical therapists know the details of all the procedures you will go through, and they carry the authority and expertise of a medical professional, which holds sway with insurance companies. If your insurance company is giving you a hard time, your physical therapist may even be willing to speak with them on the phone on your behalf.
4) Draft a Letter
Even if your insurance company denies your physical therapy insurance request, you don’t have to take no for an answer. The most common way to challenge a denial of physical therapy insurance coverage is to draft a letter challenging the decision. This is where having a solid relationship with your physical therapist comes in handy, because many therapists and doctors will draft a letter challenging the insurance company’s decision on behalf of the patient. If a medical professional believes that a certain procedure is necessary for a patient’s treatment, insurance companies will often defer to a professional medical opinion and extend coverage for physical therapy insurance. Remember to keep the letter professional and courteous but firmly state the reasons why you think you are entitled to physical therapy insurance coverage. Letters from a medical professional are generally preferable to letters from patients, but both options are fairly common.
5) Stay Positive
Determination and positivity are two of the most important qualities it takes to maximize insurance coverage. It can be frustrating when your insurance company won’t honor your physical therapy insurance policy, but giving up is the worst thing you can do in that situation. Resist the urge to express anger towards your insurance company representative. Likely, the person you speak with on the phone is not actually in charge of your physical therapy insurance. Be professional and courteous, and attempt to make an ally if you can. Your insurance representative is far more likely to help you and give you the information you need if you treat them with respect and kindness. It can take time to get an insurance claim resolved, but holding a negative outlook will only make the process more frustrating for everyone involved.
6) Change Policies
Changing insurance companies can be a hassle, so this should be considered as a last resort for obtaining physical therapy insurance. It is often far more expensive to get physical therapy insurance from a new insurance company than it is to stay with your current insurance company. Preexisting conditions raise the price of all services when you are applying to a new insurance company, and most employers offer a very limited variety of options when it comes to insurance providers. However, in some cases, changing insurance companies may be your only option for obtaining the physical therapy insurance you need. Try first explaining the situation to your employer and find out if the company can do anything to help you obtain insurance coverage you are entitled to. Most companies have an employee on staff who handles insurance matters, so that person should be able to assist you in your quest to maximize insurance coverage.
7) Consider Paying on Your Own
When your insurance company refuses to pay for the physical therapy you need, you should give consideration to working out a payment plan directly with your physical therapist. Many physical therapy facilities offer special financing for patients without insurance, and you may even be able to pay on a sliding scale basis. Sliding scale programs base the payment amount on what you can afford each month. Depending on your income, your payments could end up being as low as an insurance copay. This is a viable option if your chosen facility is known for working with low-income patients and those without insurance.
8) Hire an Attorney
When all else fails and your insurance company consistently denies the physical therapy insurance coverage you believe you are rightfully entitled to according to your policy, it may be time to hire an insurance attorney. Insurance attorneys specialize in insurance law and have plenty of experience with coverage for physical therapy, so an insurance attorney is often the best person to maximize insurance coverage. Most insurance attorneys will accept a percentage of your insurance claim as payment only after you have won. Other attorneys accept a retainer fee, and others charge by the hour for consultation services. Even if you do not decide to hire an attorney to file a physical therapy insurance lawsuit, you can still buy an hour of the attorney’s time to get professional advice on how to proceed with your claim and receive coverage for physical therapy.