Tips for Maximizing Physical Therapy Insurance Benefits

Many times illnesses and injuries come by surprise. You may have never thought about your insurance policy’s coverage for outpatient therapy services — nobody wants to have to use this benefit. However, knowing some ways to maximize your coverage may be helpful in the event you or a loved one need a skilled physical therapist to work toward recovery.

Know your limits
Read your coverage handbook or call your insurance provider to determine how many outpatient visits you are allowed each year. This will help you discuss your plan with your therapist. If you have a very low number of visits per year (sometimes 20-30) or you have a policy that combines physical, occupational, and speech therapy visits, you can also ask if there is any appeal process for this limit. It is rare, but some insurance providers may make exceptions for catastrophic cases.

Understand secondary benefits
If you are covered by two insurance policies, know what benefits your secondary insurance offers. Make sure to also get an idea of how your secondary coverage works. There are plans that will follow the same rules as the primary insurance, but some will cover additional therapy if your primary provider denies the claim.

Get the best therapy possible
Your therapy plan may help you reach your goals more efficiently if you are being seen in a place that frequently handles situations similar to yours. For example, Sheltering Arms clinics have certified specialists (neurologic or orthopedic), dedicated programs (for low vision, multiple sclerosis, Parkinson’s disease, women’s health, and more), and rehab technology. These aren’t needed for EVERY case, but when you do need them, advanced technology speeds recovery.

Ask about individualized scheduling plans
Therapists can sometimes creatively schedule you to allow more therapy in one day. Some insurance policies allow for any therapy in a day to count as a visit, so making sure you schedule physical, occupational, or speech therapy on the same day. In some cases, if you can participate in a therapy for longer than the allotted session time, your therapist may keep you for more than one time block and bill this as one visit.

Do your homework
Although most people in therapy intend to do the home exercise program (HEP) prescribed by their therapist, life gets in the way and even the best intentions don’t always work. Just remember you might only spend 2-3 hours in therapy and another 112 hours without it! A HEP is a prescription to help you recover, just as the medication your physician may be prescribing, so it is important to be diligent. If you have very limited benefits for therapy, ask your therapist what you or your caregivers can be doing on your own to speed up recovery.

Stay fit
Add in or continue with structured fitness services. Luckily, Sheltering Arms offers a wide variety of fitness programs that can complement therapy services. Therapists on site can communicate with trainers and act as consultants for an ongoing plan. For instance, if you have 30 visits per year and your therapist believes you will need to use your benefit fully, you could discuss completing therapy twice a week for eight weeks, enrolling in a fitness program like PowerEx or NeuroFit for a few months, and then returning to therapy for another seven weeks. A plan like this might extend you from about four months of therapy to seven or eight!

Pay out of pocket
This option is a last resort for most people. However, if your therapist recommends you continue therapy and there is no other option, Sheltering Arms may be able to offer special payment plans. The amount will depend on what types of services you are receiving, so ask your therapists for information from our billing specialists if you need it.

At Sheltering Arms, the focus is on getting you back to doing the things you love. To learn more about our services, click here or call 804-764-1000 to schedule an appointment.