Physical therapy is an important aspect of healthcare. It can help people recover from injuries, illnesses, surgeries, and chronic conditions through exercises and movements. However, physical therapy can also be expensive, especially if someone needs multiple sessions or ongoing treatment. That’s where Tricare comes in.
Tricare is a health insurance program for military members, veterans, and their families. It covers various medical services, including physical therapy, but the extent of coverage may vary depending on several factors such as the type of plan, location, and provider. Therefore, it’s essential to understand how Tricare works when it comes to physical therapy, so you can make an informed decision about your or your loved ones’ healthcare.
“Tricare has different plans that offer different levels of coverage for physical therapy. Knowing which plan you have and what it covers can save you time, money, and hassle.”
In this blog post, we will explore the intricacies of Tricare’s coverage for physical therapy. We’ll start by discussing the basics of Tricare and its plans, then dive into what physical therapy entails and how Tricare covers it. We’ll also answer some common questions about Tricare and physical therapy, such as eligibility requirements, copays, deductibles, and referrals. By the end of the post, you should have a clear understanding of whether and how Tricare covers physical therapy and what options are available to you.
If you’re a Tricare beneficiary who needs physical therapy or wants to know more about how Tricare works, keep reading!
What is Tricare?
Tricare is a health care program provided by the United States Department of Defense Military Health System. Tricare provides medical benefits to active-duty military personnel, veterans, eligible family members and retirees, and their dependents.
Tricare offers comprehensive coverage that includes medical and dental services, prescription drugs, mental health services, and hospital stays. The coverage also includes preventive care such as physical exams and screenings for various conditions.
The Tricare medical network has more than 1 million health care providers worldwide. This extensive provider network ensures that beneficiaries have access to quality health care no matter where they are stationed or live.
Tricare’s primary goal is to ensure that military service members and their families have access to top-notch and affordable health care.
To be eligible for Tricare, you must meet certain criteria. Primarily, you must be an active-duty member of any of the seven uniformed services, including the Air Force, Army, Navy, Coast Guard, Marine Corps, Space Force, National Oceanic, and Atmospheric Administration (NOAA), and Public Health Service (PHS).
You may also qualify if you’re a retired military member or a family member of an active duty, retired, or deceased service member. Those who served in the regular military, National Guard, or Reserve components may also be eligible for Tricare depending on specific circumstances like length of enlistment or discharge type.
One common question that people ask about Tricare is whether it covers physical therapy. Yes, Tricare does cover physical therapy because it’s considered medically necessary for treating injuries or illnesses that affect body movement or function.
Tricare coverage includes physical therapy services for patients who have sustained injuries such as fractures or sprains, those who have undergone surgery or other invasive medical procedures, and those experiencing chronic pain conditions. The program does provide some restrictions about the number of visits allowed per year.
In addition to physical therapy, Tricare covers many treatments, including chiropractic care, acupuncture, speech therapy, occupational therapy, and cardiac rehabilitation. If you’re unsure whether a specific treatment is covered, consult with your provider or check online through Tricare’s website.
To receive benefits under Tricare, you must enroll in one of its eligible plans. You may choose from three available programs based on your eligibility criteria: Tricare Prime, Tricare Select, and Tricare For Life.
Tricare Prime is a managed care option that offers a lower out-of-pocket cost than traditional fee-for-service options like Tricare Standard or Extra. It’s accessible to active-duty service members, retirees, their families, National Guard/Reserve members, and certain veterans. Beneficiaries are assigned a primary care manager who coordinates all medical care.
Tricare Select offers more flexibility for finding healthcare providers but comes with higher out-of-pocket costs. Beneficiaries can self-refer to specialists without requiring a referral first. There isn’t any need to select a primary care manager in this health care plan because beneficiaries will be seen by any TRICARE-authorized healthcare provider.
Lastly, Tricare For Life is an opt-in plan and provides supplemental coverage to Medicare beneficiaries with military retiree status. It pays most of the remaining hospital and medical costs beyond what Medicare has already paid. Enrollees are required to pay Medicare Part B premiums in addition to paying deductibles and co-payments depending on the type of medical care received.
“Tricare is a vital program that provides comprehensive healthcare coverage to those who serve in the armed forces, their families, retirees, and some veterans. It ensures that our military personnel receive top-quality medical care when they need it.” – Joe Heck
Is Physical Therapy Covered Under Tricare?
Physical Therapy Coverage
Tricare provides coverage for physical therapy services to its eligible beneficiaries. The benefits are available both in network and out of network providers, depending on the plan you have enrolled for.
The exact range of physical therapy coverage may vary based on different factors such as your location, medical condition, treatment requirements and other individual parameters that may affect your eligibility.
Physical Therapy Eligibility
In order to be eligible for Tricare-covered physical therapy services, you must fall under one of the following categories:
- Active duty service members
- Retired service members and their family members (within certain limitations)
- Dependents of active or retired service members
- Survivors of deceased military personnel
- Some National Guard/Reserve members who were activated for an extended period of time
It is important to note that the extent of your coverage and eligibility criteria may differ based on the specific Tricare plan you have enrolled for. You will need to consult with a healthcare provider or contact Tricare directly to confirm your eligibility status for physical therapy services.
Physical Therapy Benefits
Physical therapy can offer numerous benefits to patients recovering from injuries, surgeries, chronic conditions or neurological disorders. Some examples of the potential advantages of physical therapy include the following:
- Pain relief and management
- Improved mobility and flexibility
- Injury prevention/recovery
- Enhanced balance and coordination
- Independence in performing daily activities
- Improved quality of life
The benefits you can expect to receive from physical therapy may vary based on your individual condition and factors that affect the treatment course. You will need to discuss your goals and expectations with a qualified healthcare provider or therapist before beginning any physical therapy program.
Physical Therapy Claims and Reimbursement
If you are eligible for Tricare coverage for physical therapy, you should be able to claim reimbursement for the costs associated with your treatment program.
To submit a claim for physical therapy services, you will typically need to provide documentation of the following:
- Your eligibility status under Tricare
- The dates of service and duration of each therapy session
- The name and credentials of the treating provider
- A diagnosis code for the condition being treated
- An explanation of what specific treatments were administered during each session
- The amount charged by the provider for each session or visit
You may also be required to coordinate with an assigned primary care physician or seek prior authorization for certain types of physical therapy in advance of receiving treatment.
“The process of claiming reimbursement for physical therapy services under Tricare can be complex and may involve paperwork, phone calls and other interactions with insurance agents, providers and supporting staff.”
It is recommended that you take time to familiarize yourself with your particular Tricare plan and verify your level of coverage for physical therapy services in order to avoid unexpected financial burden.Regardless of the extent of your coverage, seeking physical therapy if it is deemed medically necessary can be crucial in managing pain, reducing symptoms and improving overall function.
What Types of Physical Therapy are Covered?
Orthopedic Physical Therapy
Tricare covers orthopedic physical therapy for beneficiaries with conditions related to bones, muscles, joints, tendons, and ligaments. These conditions may include post-surgical rehabilitation, strains, sprains, fractures, back pain, arthritis, and sports injuries.
The goal of orthopedic physical therapy is to help patients improve their joint mobility, muscle strength, balance, and coordination through exercises, manual therapy, and modalities such as heat, ice, ultrasound, and electrical stimulation. The therapy may be provided in an outpatient clinic, a hospital, or at home under the supervision of a Tricare-authorized provider.
“Orthopedic PT helps people recover from injuries or disorders that affect muscles, bones, tendons, or ligaments.” -American Physical Therapy Association
Neurological Physical Therapy
Tricare also covers neurological physical therapy for beneficiaries with conditions related to the brain, spinal cord, nerves, and neuromuscular system. These conditions may include stroke, traumatic brain injury, multiple sclerosis, Parkinson’s disease, cerebral palsy, and spinal cord injury.
The goal of neurological physical therapy is to help patients improve their motor function, sensory integration, mobility, and independence through activities such as gait training, balance training, coordination exercises, and functional activities. The therapy may also address communication, cognition, and behavioral issues depending on the individual’s needs.
“Neurologic PT can help individuals who have had a sudden onset (stroke) OR chronic degenerative diseases (Parkinson’s or Multiple Sclerosis).” -National Parkinson Foundation
Pediatric Physical Therapy
Tricare covers pediatric physical therapy for beneficiaries under the age of 21 with conditions related to development, movement, and function. These conditions may include developmental delays, cerebral palsy, Down syndrome, spina bifida, torticollis, and genetic disorders.
The goal of pediatric physical therapy is to help children develop their motor skills, coordination, balance, strength, endurance, and play skills through activities that are fun and engaging for them. The therapy may also address sensory processing, posture, and mobility issues that affect a child’s participation in daily activities at home, school, and community settings.
“Pediatric PT helps young people who have challenges with gross motor skills (sitting, crawling, walking), balance, coordination.” -American Physical Therapy Association
Geriatric Physical Therapy
Tricare covers geriatric physical therapy for beneficiaries over the age of 65 with conditions related to aging, chronic disease, and injury. These conditions may include osteoporosis, arthritis, joint replacement, heart disease, and stroke.
The goal of geriatric physical therapy is to help older adults maintain or improve their functional abilities, independence, and quality of life through exercises, education, and environmental modifications. The therapy may focus on fall prevention, pain management, cardiovascular conditioning, and home safety assessment.
“Physical therapists can help address many conditions associated with aging, including fall prevention; management of chronic diseases like diabetes and arthritis.” -Centers for Disease Control and PreventionIn summary, Tricare covers several types of physical therapy to help beneficiaries recover from injuries, illnesses, or disabilities that affect their physical function and well-being. Depending on the individual’s needs, the therapy may be provided by a licensed physical therapist, physical therapist assistant, or other qualified healthcare professional who accepts Tricare assignment. To qualify for coverage, the therapy must be medically necessary, safe, and effective. It is recommended to consult with Tricare before starting any physical therapy to ensure coverage and follow the proper procedures.
Are There Any Limitations or Restrictions?
If you are a Tricare beneficiary and require physical therapy, it is important to understand the limitations and restrictions of your health coverage. Here are some key things to keep in mind:
Tricare covers physical therapy for beneficiaries who need medically necessary treatment. However, there are limits on how many visits per year are covered. According to the official Tricare website, patients are entitled to up to 60 physical therapy sessions per calendar year.
It is important to note that this visit limit applies only to outpatient physical therapy. If you are an inpatient receiving rehabilitative care in a hospital, military treatment facility, or skilled nursing facility, your coverage may be different.
Before beginning physical therapy, you must obtain pre-authorization from Tricare. This means that your doctor will need to submit a request to Tricare explaining why the treatment is medically necessary.
It is important to follow this step before beginning therapy, as failure to do so can result in denied coverage and out-of-pocket expenses. Make sure to talk with your healthcare providers about obtaining pre-authorization before starting any treatment.
In some cases, you may need to see a physical therapist who is not within Tricare’s network of providers. If this happens, your coverage may be different than if you had stayed within the network.
According to the Tricare website, out-of-network physical therapy is subject to higher fees and coinsurance costs. You may also have to pay upfront and file a claim for reimbursement later.
Exclusions and Limitations
While Tricare covers most medically necessary physical therapy, there are some exclusions and limitations to be aware of. For example, Tricare does not cover physical therapy for certain conditions that are considered an excluded benefit.
According to the Tricare website, some of these excluded benefits include therapy for developmental delays or disorders, athletic training, and massage therapy.
“It’s important for beneficiaries to understand their coverage limits and requirements before beginning any physical therapy treatment,” says Rachel Santora, a healthcare policy expert at PolicyGenius. “This can help avoid unexpected costs or denied claims.”
If you have questions about your specific coverage under Tricare, it is always best to consult with your healthcare provider and the Tricare representative in charge of your plan.
While Tricare covers physical therapy for eligible beneficiaries, there are visit limits, pre-authorization requirements, out-of-network costs, and exclusionary criteria that may impact your coverage. Make sure you understand your benefits and seek the appropriate care from authorized providers to ensure maximum reimbursement and minimal out-of-pocket expenses.
How Do I Find a Physical Therapist Covered by Tricare?
If you are an active-duty service member, retiree or family member looking for physical therapy coverage under Tricare, there are several ways to find a provider. Here are some ways you can locate physical therapists that accept Tricare insurance.
Tricare Provider Search
One of the most straightforward ways to find a physical therapist covered by Tricare is to use the online Tricare Provider Search tool. This online directory allows users to search for providers by location and specialty.
To use the tool, simply visit the Tricare website and enter your ZIP code and the type of care you need. You have the option to choose between “Network Providers” or “Non-network Providers.” Network providers agree to treat patients under specific terms and conditions set forth by Tricare, while non-network providers may not follow those requirements but may still provide services covered by Tricare.
The results page will then list all available providers in the area that meet the selected criteria. Users can further filter their results by language spoken, gender of provider, and practice name. Additionally, the search results provide information on each provider’s credentials, education, specialties, and office locations.
Referrals from Primary Care Manager
If you would like a referral in addition to finding providers through Tricare’s directories, you may request one from your primary care manager (PCM). Your PCM acts as a coordinator between you and other medical providers within the military’s health system. They can provide additional guidance on finding qualified providers to best suit your needs.
Your primary care manager can issue a referral if they believe it is medically necessary for you to see a physical therapist. Doing so may also help ensure that the cost of any treatment needed is fully covered under your Tricare benefits. Keep in mind that it is essential to provide a valid referral before receiving physical therapy services from any provider.
Network Provider Directory
The Network Provider Directory on the Tricare website lists all professionals and facilities that have agreed to adhere to Tricare’s standards for medical treatment quality, availability, and service. Providers listed in this directory must accept Tricare patients’ payment rates and abide by specific billing rules put in place by Tricare.
You can utilize this directory if you already know which type of care or procedure you require and want to search for providers who work within your preferred network. Similar to the Tricare Provider Search tool, you can input your ZIP code or city/state names and select the type of physical therapy needed.
The results page will display all the available options that fit the criteria you selected. The list contains information about each practitioner, including areas of expertise and contact details.
“It’s important to find a provider who meets Tricare’s requirements to guarantee coverage of necessary treatment.” – Tricare
In conclusion, finding a physical therapist covered under Tricare insurance does not need to be complicated or challenging. Utilizing online directories like the Tricare Provider Search tool or speaking with your primary care manager to request referrals are effective ways to locate qualified providers.
If you would like additional assistance, Tricare offers a customer support line that is staffed by representatives who can help answer questions regarding your health care needs under their system. Remember that it’s crucial to ensure that any care received is billed correctly to avoid out-of-pocket expenses.
What Do I Need to Know Before Starting Physical Therapy with Tricare?
If you are a Tricare beneficiary, the good news is that physical therapy services are covered by your plan. This means that if you need to seek treatment for an injury, illness or chronic condition that requires rehabilitation, you can access this service without worrying about cost.
The coverage is not just limited to outpatient care, but also includes inpatient care received at a medical facility such as a hospital or nursing home.
To access physical therapy services under Tricare, it is important to obtain a referral from your primary care manager (PCM) or another authorized provider who will help you initiate the process and guide you through the appropriate channels.
While Tricare covers physical therapy services, there may still be some out-of-pocket costs associated with these treatments that you need to be aware of.
Firstly, you may need to pay for any copayment charges required by your plan. The amount will depend on whether you see an in-network or out-of-network provider, so make sure to clarify this before receiving treatment.
Another potential cost to keep in mind is the deductible amount. This refers to the amount you have to pay out of pocket before Tricare starts covering its portion of the bill.
“Beneficiaries enrolled in Tricare Prime must receive a referral for all specialty care, including physical therapy,” says Michelle Andrews of Kaiser Health News.
In addition, if you need to extend your treatment beyond what Tricare considers medically necessary, or you want to explore alternative therapies, you may need to cover those costs yourself.
To avoid excess expenses, it’s crucial to familiarize yourself with your Tricare plan and any cost-sharing obligations involved before starting treatment. This will help you avoid financial surprises down the road.
If you are a Tricare beneficiary seeking physical therapy services, it’s important to understand what is covered by your plan and what additional costs may be involved. By working with authorized providers and reviewing your plan information carefully, you can make the most of your benefits and access the care you need without undue financial burden.
Frequently Asked Questions
Does Tricare Cover Physical Therapy for Active Duty Members?
Yes. Tricare covers physical therapy for active duty members as long as it is medically necessary and the treatment is provided by a licensed physical therapist. The number of sessions and duration of treatment will depend on the medical condition and the recommendation of the healthcare provider.
Does Tricare Cover Physical Therapy for Dependents?
Yes. Tricare covers physical therapy for dependents of active duty members and retirees. The coverage is subject to the same rules as for active duty members, including medical necessity and the requirement that the treatment is provided by a licensed physical therapist. Some plans may have specific limits or requirements, so it is important to check with Tricare for specific details.
What Are the Limits of Physical Therapy Coverage Under Tricare?
The limits of physical therapy coverage under Tricare vary depending on the specific plan. Generally, Tricare covers physical therapy for medically necessary treatment provided by a licensed physical therapist. Some plans may have a limit on the number of sessions or a maximum dollar amount. It is important to check with Tricare or your healthcare provider to determine your plan’s specific coverage limits.
What Types of Physical Therapy Does Tricare Cover?
Tricare covers a variety of physical therapy treatments, including but not limited to: manual therapy, therapeutic exercises, neuromuscular re-education, heat/cold therapy, and aquatic therapy. The specific type of therapy recommended will depend on the medical condition and the recommendation of the healthcare provider.
How Can I Find a Physical Therapist Covered by Tricare?
You can find a physical therapist covered by Tricare by using the Tricare provider directory or by contacting Tricare customer service. It is important to ensure that the physical therapist is licensed and authorized to provide treatment under Tricare. Your healthcare provider may also be able to recommend a physical therapist who accepts Tricare.