When Is Pelvic Floor Therapy Covered By Insurance?
Pelvic floor therapy helps strengthen muscles. If those muscles are weak, it can cause problems. Your doctor might say you need the therapy for health reasons.
If so, insurance should pay for it. But first, they’ll probably want a letter from your doctor. The letter has to say the therapy is “medically necessary.” This means you need it to get better or feel good.
Be ready to give documentation to your insurance company. Follow their guidelines. Then they’ll likely cover pelvic floor therapy fees. You won’t be stuck paying everything out of your pocket.
The key is showing insurance the therapy is not just for fitness. It has a medical purpose. Your doctor’s note can explain that. Then often insurance has to cover pelvic floor strengthening treatment.
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What Papers Does Insurance Want for Pelvic Floor Therapy?
To get insurance to pay for pelvic floor therapy, you need a letter from your doctor. This letter must say you need therapy for medical reasons. It can’t just be for fitness.
The letter should:
- Recommend specific pelvic floor treatments.
- Explain your health problem and symptoms.
- Say why therapy is a necessary part of feeling better.
You may need to give other papers too:
- Referral form your doctor sent to the therapist.
- Evaluation from your first therapy visit.
- Test results that relate to your pelvic floor issue.
- Claim form filled out by the therapist with codes for your diagnosis.
Stay in close touch with your doctor and therapist. Make sure they give you the right papers. Turn them into insurance following any guidelines. This gives you the best chance of insurance covering some costs of the therapy. Ask if you have any questions or issues with the documents!
Frequently Asked Questions
Does my health insurance plan cover pelvic floor therapy if my doctor says I need it?
Most plans will cover pelvic floor therapy if you obtain and submit a letter of medical necessity from your physician stating treatment is required to address specific pelvic issues. Preauthorization may be required.
What out-of-pocket costs can I expect if insurance does cover my pelvic floor therapy?
Out-of-pocket expenses may include deductibles or coinsurance of typically 10%-50% depending on your plan details and coverage terms once met. In-network providers are the most affordable.
How many pelvic floor therapy sessions will my health insurance plan pay for?
The number of sessions covered varies by individual insurance policy. Many plans cover an initial evaluation and 6-12 additional appointments before requiring a renewal of your doctor’s therapy recommendation for further treatment. Contact your insurer.