1400 N. Dutton Avenue, Santa Rosa, CA 95401

Navigating Insurance

Navigating Insurance

While physical therapy is rarely fun (excluding ESPT 🙂 ), it can be challenging to figure out your insurance benefits before even starting your program.  We’ve tried to outline some of the information below to help you navigate the waters.

Before diving into everything, the best thing to do is to either call your insurance company or talk to someone at the PT clinic and they will get the information for you.  Doing this can save a lot of headaches…and money too!

Most insurance plans do in fact cover PT services that are medically necessary.  The number of sessions you are allotted for and your copay can vary.

The catch is that even if your insurance company covers physical therapy, the clinic you want to visit may not accept your insurance.  ESPT outlines the various insurance companies we work with on our website, but it is always good to call and check.  If the PT practice does not accept your insurance, you can either go out of network (in which insurance pays less) or pay cash per visit.

Likewise, if you do not have health insurance that covers physical therapy services, you can still receive services from a physical therapist by paying cash for the services directly.

While therapy may be covered, other activities that one might think are “therapy” may not be. This could include fitness or wellness programs, sports performance enhancement, health education classes, etc…

Here are some tips to ensure you are using your plan to the most of its capabilities – especially if you have a discrepancy in your claim and the insurance company will not pay.

  1. Call your PT clinic and/or insurance provider before starting.
  2. Go to a PT clinic that you trust
  3. Be proactive
  4. Draft a letter
  5. Consider paying on your own
  6. Hire an attorney

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