Pelvic floor therapy is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues of the pelvic area. It is often prescribed to individuals who experience pelvic pain, urinary or fecal incontinence, sexual dysfunction, or other pelvic health issues. While pelvic floor therapy can be immensely beneficial for those dealing with these conditions, one common concern among patients is whether their insurance will cover the cost of these treatments. And the answer is- it varies. Typically, if your insurance plan covers outpatient physical therapy- you have coverage for pelvic floor therapy.
The Complex Landscape of Insurance Coverage
Insurance coverage for medical treatments can be a labyrinthine journey, and pelvic floor therapy is no exception. The extent to which insurance covers pelvic floor therapy can vary widely based on several factors:
- **Insurance Provider**: Different insurance companies have varying policies regarding coverage for pelvic floor therapy..
- **Diagnosis and Medical Necessity**: Insurance coverage often hinges on a documented medical necessity. If your healthcare provider determines that pelvic floor therapy is essential to address a diagnosed medical condition, your chances of coverage may improve.
- **Referral and Preauthorization**: Many insurance plans require a referral from a primary care physician or specialist before covering pelvic floor therapy. Additionally, some may require preauthorization, where your provider must obtain approval from the insurance company before treatment begins.
- **In-Network vs. Out-of-Network Providers**: Most insurance plans have a network of preferred healthcare providers and will provide coverage for services provided both in-network and out-of-network. Typically they will cover a higher percentage of the cost in-network.
- **Deductibles, Copayments, and Coinsurance**: Even if your insurance covers pelvic floor therapy, you may still be responsible for out-of-pocket expenses such as deductibles, copayments, or coinsurance. These costs can vary depending on your specific plan.
- **State Regulations**: State laws and regulations can also play a role in insurance coverage for pelvic floor therapy. Some states have enacted laws requiring insurance companies to cover certain women’s health services, including pelvic floor therapy.
- **Documentation and Coding**: Accurate documentation and coding of the therapy sessions are crucial. Properly coded claims can increase the likelihood of reimbursement.
Navigating Insurance Coverage
To maximize your chances of insurance coverage for pelvic floor therapy, consider the following steps:
- **Contact Your Insurance Provider**: There are over 18,000 different insurance companies in The United States and each has slightly different rules. To understand your individual coverage, you will need to contact your insurance company’s customer service or review your policy documents to understand their coverage for pelvic floor therapy. We know that you are busy and insurance can be confusing. We are happy to contact your insurance company for you at The Perfect Pelvis.
- **Get a Referral**: If required, obtain a referral from your primary care physician or specialist. Ensure that your healthcare provider documents the medical necessity of the therapy. Here at The Perfect Pelvis we can accept referrals from physicians, nurse midwives, chiropractors and dentists. Often, the easiest way to obtain a referral is through your online portal.
- Just call the front desk at The Perfect Pelvis. We are happy to contact your insurance provider for you to obtain any pre authorization needed. We work tirelessly to make sure that we document and code your claims so that you will get coverage of any needed therapy.
At The Perfect Pelvis, we are currently in-network with Blue Cross Blue Shield, and are a provider for Tricare. We also take Medicare. With all other plans- including Medicare replacement, but excluding Medicaid- we are out-of-network. With out-of-network plans we will still handle all the billing for you. In some cases, even insurances that we are out-of-network with will still cover the majority of the cost.
In conclusion, most insurances do cover pelvic floor physical therapy- but the amount they will cover will vary between individual plans. If you have questions regarding if pelvic floor therapy will help your particular situation and how much your out of pocket cost would be for that result, call (816) 607-3747 to set up a screening! Our current price is $57. You will get to spend 40 min with a physical therapist who is an expert in the pelvic floor. They can give you a good idea if pelvic floor therapy will help in your particular situation, how much it will help and how many visits it will take to get you there. Once you know the number of visits you need, you will have a good estimate of your total cost.