Does Insurance Cover Visits to a Newport Beach Physical Therapist

In Newport Beach, people frequently visit a physical therapist to recover from injuries or surgery, manage chronic pain, and improve mobility. One of the first questions people have about physical therapy is, “Will my insurance cover the treatments?”.  Good news! In many cases, your insurance will cover some of the costs of therapy. While navigating the complexities of insurance feels challenging at times, understanding the basics and talking to your Newport Beach physical therapist’s office about your coverage can relieve the anxiety you may have about your coverage.

Insurance Coverage for Physical Therapy

Insurance coverage for physical therapy varies widely depending on your insurance plan. Most insurance plans, including Medicare, Medicaid, and private insurance, offer some level of coverage for physical therapy. However, the extent of coverage can differ significantly.

Private Insurance

Most private health insurance plans provide coverage for physical therapy. This includes plans obtained through employers, the Covered California marketplace, or other individual plans. Coverage details depend on your specific plan, so it's crucial to review your policy or contact your insurance provider for exact information.

Private insurance typically covers physical therapy if a doctor deems it medically necessary. You may need a referral from your primary care physician (PCP) to qualify for coverage. Some plans limit the number of physical therapy visits per year, while others may require prior authorization before starting treatment.

Medicare

Medicare covers physical therapy services under Part B. Beneficiaries must pay an annual deductible and a 20% coinsurance for outpatient physical therapy services. Medicare requires a healthcare provider to certify that physical therapy is medically necessary. There's no limit on the number of physical therapy visits as long as the treatment is deemed medically necessary.

Medicaid

Medi-Cal covers physical therapy services when ordered on the written prescription of a

physician, dentist or podiatrist and rendered by a Medi-Cal provider.  Covered treatment

services include physical therapy evaluation, treatment planning, treatment, instruction, consultations and application of topical medication.  Services are limited to those necessary to protect life, to prevent significant illness or significant disability or to alleviate severe pain.

What are Out-of-Pocket Costs for Physical Therapy?

Even if your insurance covers treatment by a Newport Beach physical therapist, you may still need to make payments out-of-pocket costs for treatment. These payments arise from copayments, coinsurance, and deductibles. Copayments are fixed fees you pay for each visit, while coinsurance is a percentage of the cost of each visit. Deductibles are amounts you must pay out-of-pocket before your insurance starts covering services.

Are You Covered?

To make sure you get the most out of physical therapy in Newport Beach and get the most coverage from your insurance carrier, follow this process:

Start with Your Insurer

Read your insurance policy and talk to your insurance carrier. This helps you understand the basics, such as coverage limits, copayments, coinsurance, and deductibles. Ask about the need for referrals or prior authorizations.

Get a Referral

If your insurance requires a referral, be sure to visit your PCP to obtain a referral that specifies the medically necessary physical therapy.

Stay In-Network

Most insurance companies pay less for services provided by a therapist that is not in their network. Verify with your insurer and therapist that services will be in-network. This little step goes a very long way in minimizing out-of-pocket costs.

Talk with Your Therapist

Don’t be afraid to discuss your financial concerns with your Newport Beach physical therapist. Balanced Body Physical Therapy works with patients with and without insurance and is ready to help you too.