Anticipating Physical Therapy Cost

Rehab With and Without Insurance

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If you suffer an injury or illness, or if you have had surgery and you have a limitation in your functional mobility, you may benefit from working with a physical therapist to help you recover. But how much does physical therapy cost? One question that is often asked after an injury is, “Can I afford to go to a physical therapist?”

Healthcare costs always seem to be soaring, and patients engaging in physical therapy and rehab should take time to understand how the cost of physical therapy may affect their rehab decisions.

Paying for physical therapy can be confusing; insurance companies, deductibles, and co-payments all make paying for physical therapy (and related rehab services) seem like a daunting task. But taking a moment to learn about physical therapy costs can help you make informed decisions about your physical therapy care.

Even with healthcare costs on the rise, few people are adequately planning for the burden. Here's how a financial advisor could help.

Estimating the Cost of Physical Therapy

When you attend physical therapy, it is a good idea to have a sense of what your out-of-pocket expenses may be. Understanding how physical therapy services are billed can help you do this.

Physical therapists bill for their services based on what they do with you during your therapy sessions. Your first visit is an initial evaluation, and this session typically is billed at a higher rate than follow-up sessions.

During follow-up sessions of therapy, your therapist may bill for various treatments that are performed. For example, if your therapist performs an ultrasound and joint mobilizations, and also prescribes exercise during your session, then three separate units of therapy will be billed. Each unit will carry a different charge. Adding up these charges will give you the total cost billed.

With Insurance

If you have health insurance, you should contact your health insurance provider and ask about coverage for physical therapy prior to calling your therapist’s office. When you contact your physical therapist, ask if they are a participating provider with your health insurance company. (Staying in-network can keep costs down.) If they are, simply provide them with your insurance information, and the therapy office will submit claims for payment to the insurance company.

Insurance Cost-Sharing

Many people have insurance plans that include cost-sharing; some of the costs of services are covered by your insurance carrier, and some out-of-pocket costs are borne by you. You may also have a co-payment to pay each time you visit your physical therapist, and you may have a deductible to meet each year before your insurance coverage kicks in for physical therapy services.

If you have Medicare as your primary insurance, you should understand that your plan covers about 80% of the physical therapy claim. You may have to pay the remaining 20%. Many people have secondary insurance that will cover all or a portion of the remaining bill.

Most people have a co-payment of about $25 to $35 per therapy session. Some co-payments may be as high as $50 or $75.

Speaking with your insurance company is a good idea when you go to therapy. They should be able to give you an understanding of what your out-of-pocket responsibilities will be for each session.

Co-Payments Can Add Up

Be careful; physical therapy is often a recurring appointment, and you may attend therapy several times each week. A small co-payment can quickly add up.

Without Insurance

If you do not have health insurance, then you will have to pay for your physical therapy services yourself. When you contact your therapist’s office, simply tell them that you do not have insurance and that you wish to pay for services out of pocket. Your therapist’s office should be able to provide you with a fee schedule of charges listing the amount charged for each separate service provided by your therapist.

Once you have a copy of the fee schedule, speak with your therapist to understand which services will be offered and billed. For example, if your therapist is planning to perform electrical stimulation, therapeutic activity, and therapeutic exercise during your treatment, you can simply add up what each service costs to get an idea of how much the session will cost. Then, you can decide if you really want that particular treatment.

Ask About Sliding-Scale Plans

Your therapy office should be understanding of your situation if you do not have insurance. Many will work with you to provide the best care at the lowest cost. Most therapy sessions for people with no insurance average about $125 to $150 per session. Many therapy clinics will set up interest-free payment plans to be satisfied over a few months rather than having to make one large payment for services.

After Surgery or Injury

If you have had a sports injury like a sprain or strain, you may only require a few sessions of physical therapy to help you recover. Many people go to therapy after a minor injury to learn what to do and what not to do. Your therapist can teach you self-care exercises to perform as you recover. If that is the case, your total cost of physical therapy may be less than $100 if you have insurance or $250 to $350 if uninsured.

If you have had major surgery like a joint replacement or fracture repair, you may attend physical therapy for several months. In that case, your out-of-pocket expenses can really add up. If your surgery is elective and planned, be sure to budget appropriately; having some extra cash on hand to cover several co-payments a week for a few months is a good idea.

Equipment Cost

During your rehab, your therapist may recommend items to purchase to aid in recovery. These may not be covered by your health insurance.

Equipment may include:

Your physical therapist should be able to recommend affordable options for you to purchase if equipment is recommended. Often it is not necessary to buy the top-of-the-line equipment, and some items, like a lumbar roll or shoulder pulleys, can be homemade for very little expense.

Affordable Physical Therapy

There are several ways to make physical therapy more affordable. These may include:

  • Performing your home exercise program (thus ensuring rapid recovery from your injury)
  • Seeing a therapist who is in-network for your insurance
  • Doing therapy on your own and visiting the therapy clinic a few times a month for “booster sessions” (rather than several times a week)

While the skills and motivation offered by a licensed physical therapist may be essential in your recovery, sometimes you need to take matters into your own hands and have your therapist teach you what to do independently during your recovery process.

Summary

The cost of physical therapy can vary based on the type of therapy it is and whether or not you have insurance. If you have health insurance, you should contact your health insurance provider and ask about coverage for physical therapy prior to calling your therapist’s office. You will most likely need to cover the co-pay costs.

If you do not have health insurance, or if your insurance doesn’t cover physical therapy services, then you will have to pay for it yourself. It is worth discussing cost-saving measures with your therapist, such as payment plans or doing exercises at home.

A Word From Verywell

Working with a physical therapist can be the difference between a poor recovery and a great recovery after an injury or surgery. The cost of therapy services may be steep and may prevent many people from realizing the gains they stand to make by going to physical therapy.

If cost is a barrier to treatment for you, speak with your physician or a local physical therapist. They can often work with you to ensure that you get the best care at the most affordable rate.

Frequently Asked Questions

Which insurers cover physical therapy?

Most health insurers, like Medicare and Medicaid, cover all or a portion of the cost of physical therapy services. Private health insurers also often cover a portion of the cost. You may have some cost-sharing in the form of a deductible or co-payment. Contact your health insurance carrier to see if physical therapy is a covered service.

What is the out-of-pocket cost of physical therapy?

If you have health insurance, expect to pay anywhere from $15 to $50 per session for a co-payment. If you are uninsured, your cost for therapy may be between $100 to $250 per session.

Is there a co-pay?

Most insurance companies cover a portion of the physical therapy bill and leave a portion for you to cover as a co-pay. This co-pay is due for every session you attend in physical therapy. Contacting your insurance company and asking about your financial responsibility for rehab is a good idea.

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