Is Pelvic Floor Therapy Covered by Insurance?
Pelvic floor therapy can help treat bladder, bowel, intimacy, pregnancy, postpartum, and chronic pelvic pain concerns. Insurance coverage for pelvic floor physical therapy varies by provider, plan type, deductibles, and whether the clinic is in-network or out-of-network.
This article explains why some pelvic floor therapy clinics choose not to accept insurance and how superbills, HSA/FSA benefits, and out-of-network reimbursement may still help reduce costs. It also outlines what to expect during your first pelvic floor physical therapy appointment.
Take Flight Physical Therapy provides one-on-one pelvic floor physical therapy appointments focused on individualized care and finding the root cause of symptoms.
Is Pelvic Floor Therapy Covered By Insurance?
Many pelvic floor therapy clinics, such as Take Flight Physical Therapy, decide not to accept insurance. The reasons for this are many and include wanting to provide care without insurance companies dictating treatment plans, spending more time on patient care (rather than paperwork) and offering transparent billing. Many out of network providers want to provide the best care possible without fighting insurance companies for reimbursement or for more patient visits. Out of network providers can offer superbills that can be submitted to your insurance company should you have out of network benefits.
I have worked for many different types of clinics and unfortunately with declining insurance reimbursement in New York State there is a push to see as many patients as possible in the in-network model. This is why in many in-network physical therapy clinics you will see your therapist one on one for 15-20 minutes and then you will likely work with a tech or aide. While some patients will likely improve and meet their goals in this model, not everyone will. More so, pelvic floor therapy can include an internal exam, difficult to discuss topics and pelvic floor conditions often have multi-factorial causes. This means that pelvic floor patients need more time with their providers. Take Flight Physical Therapy offers one-on-one hour-long appointments with the goal of finding the root cause of your issue.
Please know too that many providers do not make this decision lightly and understand that this model will not serve everyone. The medical system at present is flawed and there are pros and cons to both being an in network and out of network provider.
What Pelvic Floor Therapy Treats
Pelvic floor therapy treats any issues related to bladder or bowel function and can treat any concerns regarding intimacy. The pelvic floor is a group of muscles that form the foundation of the pelvic bowl and support the organs of the bladder, uterus and rectum. These muscles form a hammock or trampoline type shape and form the “floor” or bottom of the trunk.
Pelvic floor therapists also treat any kind of pelvic pian including hip, low back or tailbone pain. We can help with pregnancy concerns and postpartum rehabilitation. We treat urinary incontinence, constipation and chronic pain conditions related to endometriosis, GI conditions and recovering from abdominal surgeries.
When a Referral Is Required
In New York State, physical therapists have direct access, meaning that you can see a physical therapist without a referral for 30 days or 10 treatment visits (whichever comes first). We recommend being in touch with your primary care physician or other medical provider (OBGYN, urologist, physical medicine and rehab etc.) in regards to a referral.
Questions to Ask Your Insurance Provider
If you are interested in care at Take Flight Physical Therapy, you should ask your insurance provider the following questions:
1) Do I have out of network benefits?
2) What is my out of network deductible and how much will be covered once I have met the deductible?
3) How do I submit my super bill?
A super bill is a receipt that an out of network provider gives to you that you can submit to your insurance company (If you have out of network benefits). The superbill includes all the provider information and medical codes required.
Out-of-Pocket Costs to Expect
Pelvic floor therapists charge a per-visit rate. The rate will be openly disclosed prior to starting care. The only other out of pocket costs related may include any treatment tools that your therapist recommends, such as pelvic wands or dilators, e-stim units or exercise bands or weights.
Using HSA or FSA Benefits
It is important to remember that you can absolutely use your HSA or FSA benefits to pay for out of network physical therapy. It’s a great way to use these benefits for your medical care!
What Happens During Your First Visit
During your first appointment, we will go over your personal history, concerns and goals. We will discuss your symptoms, past medical and surgical history, lifestyle and more. For this portion of the appointment, you will be seated comfortably.
The next part of the appointment will involve an internal or external assessment. Often, the pelvic floor physical therapist will use a pelvic model to explain anatomy. The model is also used to explain what an internal pelvic floor assessment involves and to answer any questions. Then the therapist and patient decide together if an internal assessment is appropriate for the first visit. Remember an internal assessment is never required and the choice is fully yours as the patient!
Otherwise, an external assessment can be performed. may involve watching you walk, squat, lunge, hinge or stand on one leg. It can also include testing specific muscles for strength and endurance. There may be some hands-on treatment including gentle manual therapy techniques. Therefore, it is important to choose clothing that is comfortable enough to move around in.
The last part of the appointment will include a summary of the therapist’s findings and next steps. The therapist will outline future treatment and what will be most beneficial for the patient to reach their goals.
When Pelvic Floor Therapy Is Worth Paying for Yourself
This question ultimately boils down to what works best for you. The benefit to seeing an out of network pelvic floor provider is that usually we are only working with pelvic floor patients and have extensive experience in this specialty. We can offer more expertise and have more “skin in the game” so to speak since we are working for ourselves instead of another company. We also have an hour one-on-one with you, so most patients come in one time a week max, as opposed to in-network models where patients are being seen twice a week. We also work with you one on one and have a lower patient case load meaning that we can devote more of our attention and resources to your situation.
Where to Find Pelvic Floor Physical Therapy in Queens, NYC and Midtown Manhattan
If you are experiencing pelvic floor symptoms, help is available! Pelvic floor physical therapy can help with pelvic pain and bladder, bowel and intimacy issues. If you are in the Forest Hills, Queens, NYC area or Midtown Manhattan, and you are looking for help today, reach out to us! Take Flight Physical Therapy specializes in pelvic floor physical therapy in Forest Hills, Queens, NYC. Give us a call or fill out our contact form today!
