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Physical Therapy: What Happens if Your Insurance Coverage Stops?

By Biagio Mazza, DPT, Elite Sports Medicine and Physical Therapy

What Happens if Your Insurance Coverage Stops

Wellness can be broadly defined as proactively caring for your body, mind, and soul. The World Health Organization defines health as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The National Wellness Institute defines wellness as, “an active process of becoming aware of and making choices towards a more successful existence.” The unfortunate reality is that insurance companies DO NOT recognize wellness as a covered service.

What is Medical Necessity and Why are Wellness Services Not Covered by Insurance?
Great Question! While the definition of “medical necessity” for Physical Therapy (PT) can be confusing, we can simplify things by saying: “Can you improve functionally with skilled Physical Therapy?”

In other words, insurance companies don’t care about your level of pain. They care about what you can and cannot do as a result of your pain. It doesn’t matter to them if it hurts to raise your arm up, it matters if you can’t reach overhead to get into a cabinet. Also, insurance will not pay for “maintenance” care. So, you have to be able to predict and document IMPROVEMENT with functional activities for PT to be covered!

New PT Plus Program
To combat this problem, Elite has developed what we call PT Plus!! PT Plus is a unique and innovative way for you to avoid the constraints of insurance based care. Simply put, PT Plus allows you to continue with care even when your insurance company says “no.”

In addition to PT Plus, we have developed a suite of services, beyond Physical Therapy, to help you achieve your specific goals, including:
• Personal and Group Fitness Sessions
• Group Fitness Classes
• MOGA or “Manual Yoga”
• Injury Screenings
• Lymphatic Drainage

Did YOU Know:
• Your first visit to Elite will include a detailed initial evaluation. This evaluation will help your therapist to identify your problems using special
testing procedures.
• Once your PT has evaluated your condition, they will be able to design a plan of care that specifically meets your needs. As a part of the program design, expect a treatment timeline with realistic goals. This timeline may be changed as you progress, depending on how well your body responds to treatment.
• Along with regular visits to Elite, you will most likely receive a home exercise plan in which you will be given specific exercises to do at home in
between your regular office visits. This will help facilitate faster recovery, so stick with the program at home!
• You should always speak openly with your therapist if you have any concerns or limitations.

We will work with you closely and help you recover as quickly as possible.

Physical Therapy – It’s YOUR Choice
• YOU have the right to choose your physical therapist! When you get a physical therapy referral from your physician, you can visit any    provider you like. Much like taking a medication prescription to any pharmacy you like, the choice is yours.
• It’s common for the physician’s office to recommend a provider if the office is familiar with or has an affiliation with that provider. However, you can either visit the provider recommended by your physician, or any other provider with whom you feel comfortable.

Dedicated To Enhanced Health, Wellness and Fitness
To learn how PT Plus can enhance your health, wellness and fitness, please contact the professionals at Elite Sports Medicine and Physical Therapy. Call 913-888-0014 (in Kansas) or 816-941-2550 (in Missouri), or visit us online at

*0%, 12 Month Financial Assistance Available for All Services

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