Pelvic floor dysfunction affects millions of people, causing issues like incontinence, pain, and sexual dysfunction. Pelvic floor physical therapy can provide immense relief for those dealing with pelvic disorders. However, many wonder – is pelvic floor therapy covered by insurance? Understanding your insurance coverage is crucial when considering this treatment. This guide will explain pelvic floor therapy, whether insurance covers it, how to get an appointment, and what to expect during pelvic physical therapy sessions.
What Is Pelvic Floor Therapy?
Pelvic floor therapy, also known as pelvic physical therapy, entails working with a specialized physical therapist to address pelvic pain, incontinence, and other dysfunctions. Pelvic floor physical therapists are extensively trained in evaluating and treating pelvic muscle, nerve, and organ issues.
Physical therapists specializing in pelvic health can detect impaired muscles or nerves in the pelvic region using techniques such as internal and external massage, biofeedback, stretching, and targeted exercises. The treatment aims to relax tight pelvic floor muscles, strengthen weak ones, improve nerve function, and coordinate appropriate muscle contractions.
Pelvic floor therapy sessions consist of both external and internal massage and exercise. Treatment plans are designed to address each patient’s specific symptoms and dysfunctions. Many people find significant relief from this rehabilitative approach.
Does Insurance Cover Pelvic Floor Therapy?
Your insurance plan determines whether or not pelvic floor physical therapy is covered. Many policies offer at least some coverage, but coverage levels can vary.
Most private health insurance and Medicare Part B cover occupational, physical, and speech therapy. Pelvic floor therapy provided by a licensed physical therapist is typically considered rehabilitation services. In-network and out-of-network options may be available.
However, coverage is frequently determined by whether the therapist is a member of your insurance company’s network. An in-network provider reduces out-of-pocket expenses by lowering copays and coinsurance rates. Out-of-network therapy may not be covered, or you may be responsible for a larger cost.
Furthermore, some plans limit the number of therapy visits allowed yearly or require prior authorization. Check your policy details to determine how much therapy is covered and any other requirements.
Your insurance company may require a doctor’s referral and medical necessity documentation demonstrating how pelvic floor therapy would treat your condition. Keeping detailed records can help to meet these administrative requirements.
How Do I Get an Appointment With a Pelvic Floor Therapist?
If you’re considering pelvic floor therapy, take these steps to get started:
- Ask your doctor for a referral to a pelvic floor physical therapist. Having a referral can make insurance billing easier.
- Search online directories through organizations like the American Physical Therapy Association to find therapists specializing in pelvic health.
- Check that the therapist is in-network with your insurance to minimize out-of-pocket costs.
- Call the therapist’s office about availability, insurance coverage, costs, and other questions.
- Once your appointment is scheduled, contact your insurance to verify coverage. Get any preapprovals needed.
- Provide the therapist’s office with your insurance information and any physician referral or prescription required.
- Be prepared to pay your share of session fees per your insurance plan. This may involve a copay or coinsurance payment.
Take the time to understand insurance requirements so that billing and payment go smoothly. Read your plan details and call member services with any questions on your physical therapy benefits.
What’s Involved in Pelvic Floor Physical Therapy Sessions?
If you decide to pursue pelvic floor therapy, your sessions will involve specialized techniques to treat your unique dysfunction. However, certain components are common in most pelvic rehab programs.
Exercises and Movements
Your therapist will guide you through exercises and movements designed to strengthen or relax the pelvic floor muscles as needed. Activities may involve contracting and relaxing the muscles, yoga poses, Kegels, or coordination exercises. The therapist will monitor your progress and adjust activities over time. Proper relaxation and contraction of the pelvic muscles are key goals.
Kegels
Kegel exercises strengthen the pelvic floor muscles. You’ll learn to squeeze these muscles for several seconds and then fully relax them. Adding Kegels into your routine can improve pelvic control and function over time. Your therapist will ensure you use the proper form.
Electrical Stimulation
Pelvic physical therapists sometimes use electrotherapy techniques like electrical stimulation or biofeedback. Mild electrical stimulation can help identify and target specific muscle groups needing rehabilitation. Biofeedback lets you visualize your muscle contractions on a monitor to improve awareness and control.
Trigger Point Therapy
Your therapist may apply trigger point massage to release knots and tension in the pelvic floor muscles. This direct massage can reduce muscle spasms and pain. Patients often find trigger point therapy provides significant relief when incorporated into an overall exercise program.
Each pelvic floor therapy plan includes diverse hands-on techniques, exercises, relaxation training, and health education. Your therapist will guide you through the methods most helpful for your needs. Consistency is key for rebuilding strength and function.
Also Read: Is Ketamine Infusion Covered By Insurance?
Contact the Pelvic Health Experts
Pelvic floor disorders affect the quality of life for many. If you’re dealing with pelvic pain, incontinence, or sexual dysfunction, specialized physical therapy may help. Take time to understand your insurance coverage for pelvic floor rehabilitation. Then, connect with a therapist qualified to evaluate and treat your unique pelvic condition.
FAQs about pelvic floor therapy coverage
Why is pelvic floor therapy not covered by insurance?
Pelvic floor therapy may not be covered by insurance for a few reasons:
- The therapist is out-of-network with the insurance provider. Going out-of-network typically means higher out-of-pocket costs.
- The insurance plan classifies it as an excluded service or does not consider it medically necessary. Policies differ in covered services.
- The maximum number of yearly visits for physical therapy is exceeded. Many plans limit therapy visits per year.
- Proper preapprovals were obtained after a period of time. Preauthorization is often required.
- The condition is considered pre-existing, so exclusions apply in the first year of coverage.
How much does pelvic floor rehab cost?
Without insurance, pelvic floor physical therapy typically costs between $100 and $250 per session. The national average cost per visit is around $150. Those with insurance typically pay less per session due to negotiated rates and cost-sharing options. The total cost is determined by the number of recommended sessions and the type of insurance coverage.
Does insurance cover pelvic floor therapy in Canada?
In Canada, pelvic floor therapy coverage varies by province and insurance plan. Some provincial health insurance plans, such as OHIP in Ontario, do not cover physical therapy. Private extended health insurance may cover pelvic rehab, but each plan differs. Many Canadians cover the cost of pelvic floor therapy themselves.
Is pelvic floor therapy worth it?
Yes, pelvic floor therapy is regarded as an effective treatment for many individuals suffering from pelvic floor disorders such as pain, incontinence, and sexual dysfunction. It includes hands-on techniques and exercises for strengthening and relaxing the pelvic muscles as needed. Therapy seeks to restore control and function. Most patients see significant improvement in their symptoms after consistent rehab. It’s something worth looking into, especially if your insurance covers it. Check with your provider.
