Don’t Lose Those Year-End PT Benefits 

Many people don’t consider what type of insurance coverage they have for physical therapy until something happens that necessitates treatment. Different types of insurance plans place various limits and allowances on the amount of physical therapy they will cover over a year’s time. Typically when you schedule your first physical therapy visit the clinic will verify your benefits and tell you this information before the appointment but it is always a good idea to talk with your insurance company ahead of time. 

Commercial, federal, and state-funded insurance plans can vary widely on their coverage but here are some different scenarios that you may encounter:

• A doctor’s referral is required for the initial visit (this can vary based on insurance and also whether the state has direct access that allows physical therapists to treat a patient without a physician referral)

• A patient can make an appointment for an initial evaluation without a referral from a physician 

• A patient can be seen for the initial evaluation but the clinic must request authorization for a prescribed number of follow up visits before they can be scheduled

• A patient can be seen for the initial evaluation and then schedule follow ups without additional authorization from insurance

• The number of allowed visits per year is decided by the insurance plan (example 15, 30, 40 visits) and more cannot be requested, even if they are needed, until the insurance plan renews

• The number of visits is “based on medical necessity” and it is up to the physical therapist to provide documentation that supports the need for ongoing therapy. Some plans will require intermittent authorizations be performed to ensure it is medically necessary before agreeing to more visits. 

WHAT HAPPENS AT THE END OF THE YEAR?

Most insurance plans renew on January 1 but certain plans may renew at other times of the year. Be sure to look at your policy so you know when your benefits and deductible will start over. As you approach the end of your insurance year, it’s time to think about what to do with remaining physical therapy benefits. Unused health insurance benefits do not roll into the next year so if you don’t use them, you lose them. 

WHY SHOULD I CONSIDER PT AT THE END OF THE YEAR?

Physical therapy is an excellent way to address injuries, aches, and pains, weakness, balance problems, pelvic floor dysfunction, and more. You do not need to wait until your symptoms are severe to seek help. In fact when possible, it’s better to begin addressing these symptoms early on. 

If you have a limited number of physical therapy visits available to you each year you can maximize the number of visits you have by using some before your insurance year ends. For example, if you have a chronic condition or severe injury and anticipate needing a long course of rehab but have a hard limit of 30 visits per year, starting your course of care before the year ends allows you to get more than 30 visits for one course of care. For example you may have ten appointments in December and then use ten visits in January which equals twenty visits but you still have twenty more visits to use throughout the rest of the year. If you started that care in January you would have only ten visits left to use for the rest of the year. 

If you have met your deductible then your out of pocket expense may be lower depending on whether you have a co-insurance to pay or have met your out-of-pocket expenses for the year. This can save you a lot of money that you may not have wanted to spend early in the year. Once the insurance renews for the next year you are once again responsible for the entire deductible. Physical therapy visits can occur one to three times a week so taking advantage of the time when your deductible has already been met can save you money. 

If you have a medical or health flexible spending account (FSA) and are approaching the end of the year you may want to act now. An FSA is a medical spending account that works like a savings account and is provided by certain employers. Pre-tax money is deposited throughout the year up to a maximal amount ($2850 in 2022) and can be used to pay medical expenses like copays, vision expenses, over-the-counter medications, etc.. Since the money is “pre-tax” you will be saving the money that would typically be taken out as taxes. 

In the past, only 20% of the annual contribution limit could be carried over into the next year. All other unused funds would be lost. Recently, as part of COVID-19 relief, the Consolidated Appropriations Act, 2021, signed into law at the end of 2020, and IRS Notice 2021-15, issued February 2021 all remaining unused funds from accounts in 2020 could be carried over into the plan year ending in 2021, and account balances from year 2021 could be carried over into the plan year ending in 2022. This means that in the past two years no funds were lost. It is important to note that many of the rule changes for FSAs in 2020-2022 are not mandatory for employers to adopt. Also, it is unclear if this same rule will be renewed going into 2023, so stay tuned as the year progresses. If this benefit is not renewed into 2023 and you are nearing the end of the year and still have unused funds in your FSA, this is a good time to schedule appointments with a physical therapist as the money can help cover any copays or coinsurance you owe. 

If you have a health savings account (HSA) this is another tool you can use to cover the cost of therapy near the end of the year. Like an FSA a health savings account consists of pre-tax dollars deposited into the account throughout the year and used for medical expenses. Annual inflation-adjusted limit on HSA contributions will be $3,650 for self-only and $7,300 for family coverage in 2022. Unlike an FSA which can be sponsored by any employer, an HSA is associated with a high deductible health plan. Also, money deposited into an HSA rolls over from year to year and has the potential to earn interest. If you have money in your HSA at the end of the year you can use it to cover therapy expenses. 

In the end, we don’t always get to choose the time of year that we need physical therapy as we often don’t have control over when and how injuries or illnesses occur. If you do find yourself near the end of the year, having some aches and pains, don’t leave those benefits on the table. Call and schedule a physical therapy assessment and get started on your care right away. You may find you enjoy physical therapy so much that you are happy to save some visits in the next year, just in case. 

Give Evolve Physical Therapy in Brooklyn a call today to see how you can use your end of year benefits! Call: 1-718-258-3300

About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

Multiple Brooklyn Physical Therapy Clinic Locations!

1-718-258-3300

https://EvolveNY.com