Navigating insurance and physical therapy can feel like an uphill battle. Many people assume that if they have health insurance coverage, their treatments will be fully covered—but that’s far from the truth. The reality is that insurance companies determine what they consider medically necessary, often denying coverage for treatments prescribed by doctors.
At MOVE Performance, we understand that dealing with insurance for physical therapy can be overwhelming. Unexpected denials, unclear coverage limits, and high out-of-pocket costs leave many patients feeling frustrated and uncertain about their options.
Our goal is to empower you with knowledge and provide clear answers to some of the most common insurance-related questions, including:
Many major insurers, including Cigna and Blue Cross Blue Shield, require a clinical summary after the fifth visit. At that point, a person who has never met you decides whether your treatment should continue. Even if you have post-surgery physical therapy orders, insurance companies make the final call—not your doctor.
Believe it or not, paying out of pocket for physical therapy can sometimes be more affordable than using insurance—especially if you have a high-deductible insurance plan.
In-network providers agree to set rates that might not always be the best deal.
Insurance deductibles, co-pays, and co-insurance often add up to more than the self-pay rate.
Many physical therapy clinics offer cash discounts that are significantly lower than contracted insurance rates.
Before scheduling an appointment, ask:
What is my insurance-contracted rate per visit?
What is the self-pay rate for physical therapy?
If the out-of-pocket cost is lower, consider bypassing insurance for PT treatments and paying cash instead.
One of the most frustrating parts of insurance coverage for physical therapy is claim denials. Even if a doctor recommends treatment, insurers can deny it for reasons like:
It’s deemed “not medically necessary.”
The treatment is labeled “experimental.”
You’ve exceeded the number of covered visits.
Steps to Appeal a Denied Physical Therapy Claim
A recent Fox News report revealed that an insurance company denied coverage for a surgery mid-procedure. If insurers are making real-time decisions during surgeries, imagine how often they deny essential physical therapy treatments.
This is why self-advocacy is critical. Knowing your insurance rights and how to challenge denials can make all the difference in getting the physical therapy care you need.
The health insurance system is flawed, often prioritizing profits over patient care. Physical therapy is crucial for recovery, yet many patients are forced to fight for the coverage they’ve already paid for through their insurance premiums.
✔ Review your insurance policy to understand physical therapy coverage limits.
✔ Compare self-pay vs. insurance rates—you might save money by paying cash.
✔ Advocate for yourself—challenge denied claims and request an Independent Medical Review (IMR) if necessary.
At MOVE Performance, we see how insurance challenges affect patients daily. That’s why we’re committed to educating and empowering you to make informed healthcare decisions.
Don’t let insurance companies dictate your recovery. Take control of your care, ask questions, and fight for the coverage you deserve!
