Pelvic floor therapy is a specialized form of physical therapy aimed at treating dysfunctions of the pelvic floor muscles. These muscles support various organs, including the bladder, bowel, and, in women, the uterus. When these muscles are weak or too tight, it can lead to issues such as incontinence, pelvic pain, and sexual dysfunction. But what do insurance companies call pelvic floor therapists, and how do they handle coverage for such treatments? Let’s dive into the details.

What Do Insurance Companies Call Pelvic Floor Therapists?

Insurance companies typically refer to pelvic floor therapists as physical therapists or physiotherapists who specialize in pelvic health. These professionals often hold additional certifications in pelvic floor therapy, such as a Certificate of Achievement in Pelvic Physical Therapy (CAPP) or a Women’s Health Clinical Specialist (WCS) designation¹.

Is Pelvic Floor Therapy Covered by Insurance?

The good news is that many insurance plans do cover pelvic floor therapy, especially when it is deemed medically necessary. Major insurance networks like Medicare, Blue Cross Blue Shield, Cigna, Aetna, United Healthcare, and Humana typically include coverage for pelvic floor physical therapy². However, the specifics can vary widely depending on your individual policy and location.

For instance, Medicare Part B covers outpatient physical therapy, including pelvic floor therapy, if it is medically necessary. However, there is an annual cap on the amount Medicare will pay for outpatient therapy services². On the other hand, Medicaid coverage varies by state, so it’s essential to check your state’s specific guidelines².

Steps to Verify Insurance Coverage

1. Contact Your Insurance Provider: The first step is to call your insurance company directly. Ask if pelvic floor therapy is covered under your plan and what the requirements are for coverage.
2. Get a Referral: Some insurance companies require a referral from your primary care physician or a specialist. Make sure to get this referral if needed.
3. Check for Pre-Authorization: Some plans may require pre-authorization before you can start therapy. This means your therapist will need to submit a treatment plan to the insurance company for approval.
4. Understand Out-of-Pocket Costs: Even with insurance, you may have co-pays, deductibles, or other out-of-pocket expenses. Make sure you understand these costs upfront.

Why Pelvic Floor Therapy is Important

Pelvic floor therapy can significantly improve the quality of life for individuals suffering from pelvic floor dysfunction. It can help with:

• Urinary Incontinence: Strengthening the pelvic floor muscles can help control bladder function.
• Pelvic Pain: Therapy can alleviate pain caused by muscle tightness or spasms.
• Sexual Dysfunction: Improving muscle function can enhance sexual health and reduce pain during intercourse.
• Postpartum Recovery: Many women benefit from pelvic floor therapy after childbirth to regain muscle strength and function.

Finding the Right Pelvic Floor Therapist

When looking for a pelvic floor therapist, it’s crucial to find someone who is experienced and makes you feel comfortable. Here are some tips:

• Check Credentials: Look for therapists with specialized training in pelvic floor therapy.
• Ask for Recommendations: Your primary care physician or gynecologist can often recommend a good therapist.
• Read Reviews: Online reviews can provide insight into other patients’ experiences.
• Consult Multiple Therapists: Don’t hesitate to consult with a few therapists before making your decision.

Conclusion

Pelvic floor therapy is a valuable treatment for many individuals, and understanding your insurance coverage can help you access this care without unnecessary financial stress. Always verify your coverage details with your insurance provider and consult with qualified therapists to ensure you receive the best possible care.

For more detailed information on pelvic floor therapy and insurance coverage, you can visit CityPT or ZayaCare.

¹: CityPT ²: ZayaCare

Feel free to ask if you need more specific details or have any other questions!