Pelvic Floor Therapy Insurance: Are You Covered?
by Hollie Champion, PT, DPT
Pelvic floor therapy should be the first line of treatment for pelvic floor dysfunction. But my patients often wonder, is pelvic floor therapy covered by insurance?
While insurance plans vary dramatically, there are some instances in which pelvic physical therapy is covered by insurance.
Let's dive into pelvic floor dysfunction and pelvic floor physical therapy a bit more, consider other payment options, and explain why it's crucial to find a pelvic physical therapy expert that feels like a good fit for you.
- Insurance coverage for pelvic floor therapy varies widely.
- Direct verification with your insurance provider is essential.
- Understanding out-of-pocket payment options is beneficial.
- Does Your Insurance Provider Cover Pelvic Floor Dysfunction?
- What Constitutes Pelvic Floor Dysfunction and Symptoms?
- Pelvic Floor Therapy Treatment Options
- Finding the Best Pelvic Floor Therapist for You
- Cost and Benefits of Pelvic Floor Treatment Without Insurance
- Pelvic Floor Therapy Coverage Bottom Line
Most insurance providers cover pelvic physical therapy, especially if medically necessary. As pelvic floor dysfunction is a serious medical condition, many government and private insurance companies do cover it. Still, you will have to check with your provider to make sure.
You can also call around and check with physical therapists. Find out which insurance they accept and ask about any out-of-pocket costs you may be responsible for.
Some insurance companies may want a referral from your physician or a diagnosis of your condition.
The pelvic floor is a set of muscles in the shape of a hammock that supports many organs in your pelvic region. However, if you have pelvic floor dysfunction, some of these organs may not perform the way that they should and can cause some discomfort.
A pelvic floor dysfunction is a condition where you have difficulty controlling your pelvic floor muscles, leading to an inability to properly contract and relax them throughout the day, such as during bathroom use.
The pelvic floor consists of connective tissues, ligaments, and muscles that support the organs in the pelvis and keep them safe. These organs include the following:
- Uterus (female)
- Vagina (female)
- Prostate (male)
I have patients that experience issues with their pelvic floor muscles being either too tight or too weak, or a combination of both. I've seen this imbalance affect their muscle function in various ways, including during toileting, physical activities, or sexual intercourse. For instance, weak pelvic floor muscles can lead to incontinence, causing unintentional — and sometimes embarrassing — leakage of urine or fecal matter. Conversely, they might also result in difficulties with effectively expelling these substances.
Many women believe these problems only exist after you have had children. This is not always the case. I have many patients who have never had children and have sought care for different types of pelvic floor dysfunction.
It's estimated that around 1 in 3 women have pelvic floor dysfunction. This estimate doesn't include the ones who don't seek help for the issue, as some people may be uncomfortable discussing pelvic health, making pelvic floor dysfunction vastly underdiagnosed.
By the way, women are not the only people to have pelvic floor dysfunction; men can also have it. Men with pelvic floor dysfunction may develop erectile dysfunction or swelling of the prostate gland.
Symptoms may vary, but some of the possible symptoms include the following:
- Trouble urinating
- Starting and stopping during urination
- Painful urination
- Leaky stool or urine
- Frequently having to go to the bathroom
- Straining to have a bowel movement
- Lower back pain
- Pelvic pain
- Painful sexual intercourse
If you have pelvic floor issues, pelvic floor treatment will provide several benefits. Some of these benefits include:
- Reducing pain
- Restoring the proper function of organs and muscles
- Improving bladder and bowel control
- Treating pelvic organ prolapse
- Improving sexual function
One of the first things a pelvic physical therapist will do is offer you more education on the pelvic floor area. They may also suggest some potential lifestyle changes or exercises you can do on your own to improve your condition.
Let's look at pelvic floor physical therapy options that your pelvic physical therapist may use.
Pelvic floor exercises are an excellent option to help to strengthen and improve the function and mobility of the pelvic floor muscles. While exercise programs vary from patient to patient depending on their goals and condition, some exercises your pelvic floor physical therapist may have you try include:
- Bridge pose
- Toe taps
- Pelvic floor lengthening
- Heel slides
- Happy baby pose
- Deep diaphragmatic breathing exercises
Don't be fooled! Kegels are far from the only exercise we prescribe! I have had many clients who have been doing them on their own for years and they weren't the most appropriate option for treating their symptoms.
Biofeedback involves using sensors to check for contractions of your pelvic floor muscles. Physical therapists use biofeedback as a great tool to help strengthen weak muscles or loosen up tight muscles.
Some medications can help people who have pelvic floor issues. Your doctor might choose to recommend a medication based on your symptoms. Some common recommendations include a stool softener for people who have trouble going to the bathroom. Botox injections may help people with tight pelvic floor muscles relax more easily. However, I'd again like to emphasize that the necessity for any medication varies by patient.
Dry needling involves inserting small, non-injectable needles on or around pelvic floor muscles, connective tissues, or trigger points. The needle causes a contraction and helps to relax the muscles or area.
Trigger Point Treatment
Trigger point treatment focuses on manually releasing tense segments or 'knots' in the pelvic floor muscles. A pelvic floor physical therapist, skilled in these techniques, can not only perform these releases but also teach you how to perform them on yourself. They may even choose to show you how to effectively use tools like dilators or vaginal wands for self-treatment at home.
Electrical stimulation is a pain-free treatment that involves sending an electrical current to stimulate nerves and muscles in the pelvic floor region. The pelvic floor muscles will contract, and this helps to strengthen them.
Finding the best pelvic floor physical therapist is essential. Pelvic floor health is a sensitive topic — you want to be comfortable with whoever you work with.
Some factors include:
- Appointment time: You should see how long the appointments are. For example, if you have a condition that may need more work, you could receive more specialized care and save money by having longer appointments.
- Continuing Education: You should check if the clinic or therapist has taken continuing education classes emphasizing the pelvic floor area.
- Experience: You should find out if the clinic has experience treating your condition, and if so, what are their go-to pelvic floor treatment methods for it?
- Specialty Clinic: You'll want to check if pelvic floor therapy is offered in a specialty clinic with a practice dedicated to pelvic health.
- Insurance or cash-based: You'll want to ask if they take insurance and if the providers are in or out of your network. You can also ask to see if they are cash-based. Oftentimes, the total cost of care for cash-based treatment is less than using insurance.
- Internal and external treatment: Most pelvic floor physical therapists are trained to assess your pelvic floor muscles through internal examination, either via the vaginal or rectal canal. This approach provides a more detailed understanding of your pelvic floor's functionality. However, if you are uncomfortable with internal examination, it is not mandatory. The decision to proceed with internal assessment is entirely up to you.
You should still seek treatment even if your insurance doesn't cover pelvic physical therapy. If you let pelvic floor dysfunction continue without treatment, your symptoms could get worse, and you could end up needing surgery later. In my experience, the cost of a course of pelvic floor PT is much less than what surgery or more invasive procedures will cost.
On average, a pelvic floor therapy session can range between $80-$250 or more, depending on your specific treatment. Although paying out of pocket for pelvic floor therapy may seem challenging, financial options are usually available.
Some physical therapy providers offer cash-based treatment. One of the benefits of cash-based physical therapy is that you can receive all the care and attention you deserve without having to share pelvic floor physical therapists with others.
Often, insurance companies only pay a set rate for therapy, and many pelvic physical therapy clinics must overbook themselves to compensate for the lower fees.
We know you may still have some questions, so here are some common questions and answers about pelvic floor physical therapy.
Do I need a doctor's referral to go to pelvic floor therapy?
No, you don't need a doctor's referral to go to pelvic floor therapy. However, some insurance providers will require you to have a referral.
How much does pelvic floor rehab cost?
On average, one session of pelvic floor rehab can cost between $80 and $250. However, many factors can affect the cost.
Is pelvic floor PT worth it?
Yes, if you want relief from your pelvic floor dysfunction. Pelvic PT gives people better control over their bowel and bladder functions so they can have a better quality of life. It often helps people to avoid surgeries that they may have been considering for treatment of their symptoms.
Why would a doctor recommend pelvic floor therapy?
If you've been diagnosed with any pelvic floor dysfunction, a doctor could recommend pelvic floor therapy. I strongly encourage being proactive about your symptoms, no matter how minor, and asking your physician if they think therapy may be an appropriate option. Addressing your concerns early always gives you a chance of better outcomes.
How painful is pelvic floor therapy?
If you have internal treatment and the muscles are tight, you may experience some discomfort initially, but most therapy options are painless.
So, if you’re asking yourself, is pelvic floor physical therapy covered by insurance? Chances are your pelvic floor therapy is covered, but you'll want to check with your insurance company to make sure.
Then, you should check with the pelvic therapy clinic and find out if they accept insurance or if you'll need to pay for it.
If you're ready for pelvic physical therapy and want to work with a physical therapist specializing in pelvic health, contact CityPT to book an appointment today and let us help you recover.
Before you go, please read our disclaimer. This blog is intended for informational purposes only. We are not providing legal or medical advice and this blog does not create a provider-patient relationship. Do not rely on our blog (or any blog) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.