Table of Contents

Frozen Shoulder Physical Therapy – Will My Insurance Cover It?

The unfortunate individuals having to deal with adhesive capsulitis (also known as frozen shoulder) many times end up choosing frozen shoulder physical therapy as their treatment choice. If the person has decent insurance this is a wise choice, however since this condition knows no economic boundaries, many times the sufferer has less than adequate insurance and is faced with the possibility that their particular policy will not cover such services.

Traditionally in the past Medicare has always covered physical therapy services provided they are medically necessary. However there has been an ongoing battle in congress on whether to cap physical therapy services after a certain amount has been paid.

A cap is very limiting as it usually encompasses other ancillary services. This means that if someone has extensive medical problems they may have very little if any therapy covered by the time they need it. Frozen shoulder physical therapy in particular requires multiple sessions with one-on-one joint mobilization in order to achieve functional range of motion.

Recipients of Blue Cross Blue Shield insurance typically have been covered at the rate of 80/20 – that is 80% insurance responsible and 20% patient responsible. However it is becoming more frequent to see some BCBS policies limiting outpatient therapy to a number of visits per year. Good luck if you have a particularly bad year with more than one injury or surgery requiring PT. Make sure you, as the recipient of health care, do your due diligence towards what your individual policy may cover regarding therapy.

Individuals injuring there shoulder on the job may be covered by Workmans compensation. All employers with greater than 5 employees are required by law to carry Workmans compensation insurance. This does not necessarily mean treatment for your injury is covered. The resulting injury and development of adhesive capsulitis must be documented as work related.

Therefore all work related accidents or injuries must be reported to a supervisor who documents the dates and times of the occurrence as the first step. It is also a good idea to keep your own log of dates and times, mileage, etc… if you are injured during the course of performing work duties.

Medicaid recipients will need to check with their provider to see if Medicaid is accepted. If it is, then consult with the therapist directly as to how many units or allowable charges his or her plan of care may require. Medicaid restricts certain charges to a finite number per year.

All-in-all, frozen shoulder physical therapy is covered by most insurance plans in some form or fashion, but each individual will need to due a little investigation to make sure they are covered and do not end up with out-of-pocket expenses.

Physical Therapy insurance

Physical therapy is a healthcare service that aims to rehabilitate and improve a person’s physical abilities and functionality. Insurance coverage for physical therapy varies depending on the specific insurance plan you have. Here are some key points to consider:

Health Insurance: Most health insurance plans cover physical therapy to some extent, but the coverage details can vary significantly. It’s essential to review your policy documents or contact your insurance provider to understand the specific coverage and any limitations, such as the number of sessions allowed or pre-authorization requirements.
In-Network vs. Out-of-Network Providers: Health insurance plans often have a network of preferred providers. If you visit an in-network physical therapist, you may receive more extensive coverage and potentially lower out-of-pocket costs. Out-of-network providers may still be covered, but the insurance reimbursement might be less, leaving you responsible for a higher portion of the costs.
Referral or Pre-authorization: Some insurance plans require a referral from a primary care physician or pre-authorization before starting physical therapy. Make sure to understand your insurance plan’s requirements to avoid unexpected expenses.
Deductibles, Co-payments, and Co-insurance: Check your insurance policy for details on deductibles (the amount you must pay out-of-pocket before your insurance coverage kicks in), co-payments (fixed amounts you pay for each visit), and co-insurance (a percentage of the cost you’re responsible for). These factors can affect your out-of-pocket expenses for physical therapy.
Lifetime or Annual Limits: Some insurance plans impose limits on the number of physical therapy sessions or a maximum amount they will pay for such services. Be aware of these limits to plan your therapy accordingly.
Medicare and Medicaid: If you have Medicare or Medicaid, they generally cover physical therapy services, but specific rules and coverage details may vary. It’s advisable to consult the respective programs or your insurance provider for more information.

Remember to review your insurance policy documents or contact your insurance provider directly to get the most accurate and up-to-date information on physical therapy coverage. They can provide you with the specifics of your plan, including any restrictions, coverage limits, and costs associated with physical therapy services.

Insurance

Insurance is a way to protect against financial loss. It involves paying a premium to an insurance company in exchange for the promise of payment or reimbursement for certain losses or damages. Insurance can help individuals, businesses, and organizations manage risks and protect against unexpected events.

There are many different types of insurance available, including:

Health Insurance: This type of insurance helps cover the cost of medical expenses, such as doctor visits, hospital stays, and prescription drugs.
Life Insurance: Life insurance provides a lump-sum payment to the insured’s beneficiaries in the event of their death. It can help provide financial security for loved ones and cover expenses such as funeral costs and outstanding debts.
Auto Insurance: Auto insurance provides coverage for damage or injury caused by a car accident. It can also provide coverage for theft, vandalism, and other incidents.
Homeowners Insurance: This type of insurance helps protect homeowners against damage or loss to their property, as well as liability for injuries or damage caused to others on their property.
Renters Insurance: Renters insurance provides coverage for personal property and liability for renters.
Business Insurance: Business insurance provides coverage for various types of risks that businesses may face, such as liability, property damage, and employee injuries.

Insurance policies can vary widely in terms of coverage, exclusions, and premiums. It’s important to carefully review any insurance policy before purchasing it and to understand what is covered and what is not.

Insurance companies use various methods to assess risk and determine premiums, including actuarial science, statistical analysis, and underwriting. Factors such as age, health status, driving history, and location can all impact insurance premiums.

In conclusion, insurance is a way to protect against financial loss and manage risks. There are many different types of insurance available, including health insurance, life insurance, auto insurance, homeowners insurance, renters insurance, and business insurance.

It’s important to carefully review any insurance policy before purchasing it and to understand what is covered and what is not. Insurance companies use various methods to assess risk and determine premiums, and factors such as age, health status, driving history, and location can all impact insurance premiums.

Author: Mohammed A Bazzoun