Addie Morgan, a software account executive and part-time wedding planner in Atlanta, has a problem that some women would love to have -- she can only walk in high heels. But it's not because she thinks she's the next Beyonce. It's because of an inflamed Achilles tendon.
Morgan went to her doctor about it. "He said that other than giving me an injection, the best thing was to go to physical therapy and see how I did with it," she says. Her insurance plan offered 30 sessions a year. She had to pay $30 for each appointment. The insurance company paid the rest.
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Her payment method is pretty typical. Under the health reform law known as the Affordable Care Act, insurance plans offered on your state's health insurance marketplace need to include coverage of rehab like physical, occupational, or speech therapy.
To get physical therapy, you don't always need to be referred by a doctor. "We have direct access in all 50 states," says Carmen Elliott, vice president of payment and practice management at the American Physical Therapy Association. "However, an insurance company could still require that you get approval from a doctor before beginning treatment."
For occupational therapy, which helps you with skills for daily life like dressing, eating, and showering, "most insurances require a physician referral," says Christina Metzler, director of public affairs for the American Occupational Therapy Association. "It's their way of making sure that people get the right services. But some states allow people to go directly."
Sometimes your kids are able to get some types of therapy in school, without any cost to you. "Children can get occupational therapy if they're in special education and that's paid for by the schools," Metzler says.
Medicare and Medicaid
Medicare is the government insurance program for seniors and some younger people with disabilities. It typically pays 80% of the therapy cost and you pay the rest. If you have the supplemental insurance called Medigap, you'll get the whole bill paid for. Keep in mind that there's a dollar limit for these services. Once you hit it, the cost is all yours, though you're allowed to appeal for more coverage.