Does Blue Cross require a referral for physical therapy?
Asked by: Mikayla Brekke | Last update: August 21, 2025Score: 4.5/5 (67 votes)
Do you need prior authorization for physical therapy?
Often called prior authorization, pre-authorization is permission from an insurance company that is required before a patient can receive a certain type of treatment, care, or service. Virtually every payer requires pre-authorization for physical, occupational, and speech therapy.
Is physical therapy usually covered by insurance?
Most health insurers, including Medicare and Medicaid, will cover all or part of the cost of physical therapy services. Private health insurers will often cover a portion of the cost for PT as well. You may have cost-sharing for PT, like meeting your insurance deductible or copays.
Does Blue Cross Blue Shield cover physical therapy sessions?
By choosing Blue Cross Insurance for your physical therapy needs, you can enjoy the benefits of continuity of care. This means that if you require ongoing treatment or multiple sessions, Blue Cross Insurance will support your treatment plan and provide coverage for the duration of your therapy.
Do you need a referral to see a therapist Blue Cross Blue Shield?
PPO or EPO plan: No, you typically don't need to see your primary care physician for a referral to therapy before Blue Cross Blue Shield will pay for services.
Do I Need A Referral For Physical Therapy?
Does Blue Care require referrals?
Although referrals aren't required, BCN POS health plan members will have lower out-of-pocket costs when they receive services from an in-network provider. Note: Some services are only covered when performed by in-network providers, and some services require authorization by BCN.
How do I know if my PT is covered by insurance?
Review your policy documents to learn more about your insurance coverage. You can also contact your insurance provider directly. They can give you further details on your plan's coverage, limitations, and requirements to cover physical therapy services.
How much is a physical therapy session with insurance?
Note that if you have insurance to cover physical therapy, you likely won't be paying the entire amount yourself. The average copay for a physical therapy visit is between $25 and $50.
Can insurance deny physical therapy?
The goal of insurers is to pay out the least amount possible, so physical therapy may be denied simply because of the cost, regardless of the fact that your doctor believes the therapy will definitely help you recover more quickly while minimizing pain.
Does physical therapy fall under preventive care?
Do physical therapists provide wellness and preventive care? Yes, they do! While most people do not see a physical therapist until there is a problem, it does not have to be this way.
Is physical therapy covered by Anthem Blue Cross?
Yes, Anthem Blue Cross and Blue Shield does cover therapy services. However, the amount of the therapy cost they cover depends on your unique health insurance plan.
Do you need a prescription to start physical therapy?
No, you do not need a prescription to receive physical therapy. In California, patients are able to be evaluated and treated by a licensed physical therapy without a physicians referral under legislation called Direct Access.
What happens if you don't get prior authorization?
If you don't obtain it, the treatment or medication might not be covered, or you may need to pay more out of pocket. Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.
Do I need a diagnosis before going to physical therapy?
If your pain or functional limitation came on gradually, or for no apparent reason, then your condition most likely does not warrant these tests right away, and it is safe to participate in physical therapy.
Does Blue Cross pay for physical therapy?
Coverage for Physical Therapy is limited to 40 visits per benefit period. Coverage for Occupational Therapy is limited to 40 visits per benefit period. Coverage for speech therapy is limited to 40 visits per benefit period. Coverage for Physical Therapy is limited to 40 visits per benefit period.
Do most insurance cover physical therapy?
If you're in for a long recovery after an injury or surgical procedure, you're probably wondering if insurance will pay for physical therapy. The answer is yes — most insurance plans will cover medically necessary physical therapy services that are provided by a licensed physical therapist.
Do you pay a copay every visit for physical therapy?
Typically, you must pay this amount at the time of service. Again, copay amounts are fixed—which means you will always pay the same amount, regardless of visit length. In most cases, copayments go toward your deductible.
Is PT insurance worth it?
For both dogs and cats, the average annual cost of veterinary care exceeds the average annual cost of pet insurance, suggesting that pet insurance is worth it if you have comprehensive coverage. Of course, there will probably be years when you spend more on pet insurance than you save on veterinary care.
Is a physical covered by insurance?
Some commercial insurance plans consider this a preventive care visit if no new symptoms or the management of an ongoing, or chronic, health problem are discussed. Many plans cover one annual preventive care visit completely, but there may be a visit copay if you seek care for new symptoms or ongoing issues.
How do you know if your insurance requires a referral?
How do I know if my insurance requires a referral? It depends on the type of insurance that you have. Simply said, health maintenance organization (HMO) plans and point of service (POS) plans will require a referral before seeing a specialist.
Which type of insurance does not require a referral for a patient care and specialist?
A PPO is a health plan with a “preferred” network of providers in your area and does not require a primary care provider (PCP) referral to see a specialist. A PPO health plan provides more choices but typically has higher monthly premiums. With a PPO plan, you can save money if you use doctors in the plan's network.
What to do when your doctor will not give you a referral?
You can ask them why they will not refer you and request they reconsider. If they still refuse, you may want to think about finding another primary care provider who is a better fit. Your health and well-being deserve the best care possible.
Does Blue Cross Blue Shield cover therapy?
Yes, therapy covered by Blue Cross Blue Shield includes treatment for anxiety and related disorders, such as panic disorder, agoraphobia, and social anxiety.