Do I need a referral from my doctor before coming to physical therapy?
In Iowa, you are not required to have a referral unless your insurance requires one. Medicare is one insurance provider that does require a doctor referral for physical therapy, however. If Medicare provides your health insurance and you think you need physical therapy, talk to your primary care doctor.
How do I find out for sure if my health insurance requires a referral?
To know for sure if you need a referral, contact your insurance company and ask specifically about physical therapy.
How many visits does my insurance cover?
This is a tricky question, as every insurance plan is different. Medicare, for example, does not limit your visits, but rather the amount of money you spend. Depending on what is done, you can typically get 15-20 visits covered. However, Medicare does allow you to go over that amount if the physical therapy is medically necessary.
There are commercial plans that range from 20 visits to an unlimited number. Some insurance companies require approval after the first visit before deciding how many visits they will cover. The best thing you can do is contact your insurance company and ask about your physical therapy benefits.
How much does it cost?
Your cost varies depending on your insurance plan. Some insurances only require a copay, a set amount paid every visit, until you hit your out of pocket max. However, some insurances still require you to pay that copay even after you hit that out of pocket max.
There are also insurances that require you pay a deductible and coinsurance until you hit your out of pocket max. This makes your cost vary a lot more because the insurance will take their adjustments, then apply the balance toward your deductible. This means you will pay a higher amount on your visits until you hit that deductible.
After hitting that deductible you will pay a coinsurance, which is a percentage of the total cost. The most common is a 20% coinsurance, meaning you pay 20% (this can vary though, from 10% to as high as 50%). This continues until you hit your out of pocket max.
Again, to know which you are, you should contact your insurance company and ask about your physical therapy benefits. We also check benefits here and provide an insurance coverage sheet to those that have a deductible/coinsurance plan.
How often will I receive a bill?
We mail out statements once a month. They go out the 1st of the month, unless that falls on a weekend or holiday and then it will go out the following business day.
Do you think you may need physical therapy but are unsure if your insurance covers it? Fill out the following form for a billing consultation.