BCBS PPO health insurance plan covers physical therapy. According to them, “Physical therapy is covered when an IPA physician determines that such therapy is expected to result in significant improvement within two months in the condition for which it is rendered. Anticipation of significant improvement, not necessarily complete recovery, meets the criteria.”
Description of Procedure or Service
Physical therapists are trained to perform a thorough evaluation to screen patients for medical referral; in addition, physical therapists evaluate and treat neuro-musculoskeletal symptoms related to a specific illness or injury by:
- improving posture, locomotion, strength, endurance, balance, coordination, joint mobility, flexibility;
- enhancing one's ability to carry out everyday tasks;
- reducing pain or discomfort;
- creating tailored exercise plans and educating both the patient and their family with home instructions that promote independence, increased quality of life, and the return to normal functioning.
ALL of the following criteria must be met in order for Rehabilitative Therapies to be covered:
- Services are focused on the treatment of a specific disease, injury, or congenital defect; AND
- It is expected that services would result in a significant and measurable improvement in functional capabilities within a reasonable and defined period of time.
- The services are provided by a qualified and legally licensed provider; AND
- A qualified health care provider, such as a physical, occupational, or speech therapist, is needed to deliver these services; AND
- Services are deemed specific, effective, and reasonable treatment based on the patient’s diagnosis and physical condition.
A session is defined as up to one hour of therapy (treatment and/or evaluation) on any given day. For Physical therapy, the session may include up to four PT modalities.