Is pelvic floor therapy covered by insurance?
You may be wondering if pelvic floor physical therapy is covered by your insurance plan. The long and the short is: sometimes, but most times no or there are strings attached.
Most folks would assume that having insurance coverage can be extremely helpful, but it can be more cost-effective to see a cash-based (aka out-of-network) Pelvic PT.
This post will go through a few of the ins and outs of insurance-based pelvic health physical therapy and private-pay pelvic floor physical therapy.
The background of insurance coverage
Since the beginning of time (okay not really, but for a very long time) physical therapists have had to answer the question of whether or not a treatment, or in this case pelvic PT, is covered by insurance.
Insurance companies are complicated and dealing with coverage issues can be extremely frustrating! If you've had a poor experience before, I understand because so have I.
When it comes to pelvic physical therapy, we’ll oftentimes see insurance companies deem the care as not “medically necessary” when it's all said and done, which means that they won't cover pelvic floor PT treatment.
So what does this mean for you?
Let's go through the steps:
You seek out a provider who takes insurance for pelvic PT.
You assume your insurance is going to cover your treatment.
Then 10 weeks later you get a surprise bill in the mail because your insurance company decided not to cover it for whatever reason.
This is the game we play with pelvic physical therapy and addressing pelvic floor dysfunction.
But instead of playing that game, Durham Pelvic is an out-of-network practice with transparent pricing.
I do not take your insurance directly, but you can submit superbills that I can provide you after each visit to your insurance company to take advantage of the out-of-network benefits you have.
What are the benefits of seeing an out-of-network or private-pay provider?
You might be wondering why I chose to be out-of-network and not accept insurance, so let's go through the benefits:
One-on-one pelvic physical therapy: you get one full hour with your provider (that’s me!), every time. This means individualized attention to ensure that every session brings you closer to your goals.
Decreased number of visits: because each visit is longer and specific to you, I do not see you 3 times a week for 12 weeks. I typically see patients once per week for 6-8 weeks then at a decreased visit frequency after that as they are feeling better and more confident in exercising on their own.
Transparent pricing: You won't receive a surprise bill at the end of care. I share my costs upfront so that you know exactly your financial responsibility before you ever begin treatment.
Better results: when I have the time to spend one hour with you and take your whole medical picture into account, I’m better able to tailor my treatment to your specific needs. I also don't need to do only what your insurance company tells me I can do for treatment. (Did you know that was a thing? Even though your insurance carriers knows nothing about you, they can tell providers what treatments they will or will not cover, therefore dictating your treatment.) Your treatment plan is up to us and is a collaborative approach between you and your Doctor of Physical Therapy, not your insurance carrier.
Your provider isn't burnt out: Here's the thing - life is pretty dang busy and stressful for all of us. When it comes to being a health care provider, I need to make sure I’m serving you from a full cup. I remember working in an insurance-based clinic and seeing 11 patients a day. As much as I tried, I don’t think those afternoon patients got my best. In a private-pay practice, I get to decide how many patients I see per day and don't have to spend hours fighting with insurance companies. This means my mental health is better and in turn, I have more capacity to serve you best.
So to bring it all back home, I don't accept your insurance at Durham Pelvic, but I do provide you with a superbill that you can send to your insurance provider to take advantage of your out-of-network benefits if you have them.
If you'd like to schedule a FREE 15-minute discovery call to ask any questions you have, please feel free to click here to schedule. I'd love to chat.
💜 Dr. Rachel J
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