Checked before the first visit, not after the sixth
Your plan's visit limit, and what we do about it
Most commercial plans cap physical therapy visits per calendar year. The cap is frequently lower than the course a condition actually needs, and almost nobody is told the number until they hit it.
Your plan's visit cap, checked before you start. Most commercial plans cap physical therapy visits per calendar year, and the cap is frequently lower than the course of treatment a condition needs. We check your benefit before the first visit rather than after the sixth, we tell you the number, and we plan the course around it — front-loading the hands-on work and handing you more of the programme to run yourself if the arithmetic says we should.
A typical commercial plan allows somewhere between twenty and sixty physical therapy visits a year, sometimes shared with occupational and speech therapy, sometimes subject to prior authorisation after a certain point, and sometimes reviewed for medical necessity throughout. The variation is enormous and the details are not on the card in your wallet.
What matters is that the cap is a fact about your year rather than about your condition, and it interacts badly with the way most courses of treatment are planned — which is to say, not planned at all until the visits run out.
What we do before you arrive
Verify the benefit. Visits allowed, visits already used this year, copay or coinsurance, whether a referral or prior authorisation is required, and whether the allowance is shared with other therapy disciplines.
Then tell you the number, in plain terms, before your first appointment rather than as a discovery somewhere around visit twenty. If the number is bad we would much rather you know while you still have all your options.
A benefit check is a good-faith estimate rather than a guarantee — insurers say so themselves and we are not going to pretend otherwise. What it is not is optional, and a clinic that does not do one is passing a risk to you that it is far better placed to carry.
How a tight cap changes the plan
Front-load the hands-on work. If you have twelve visits for a problem that would ordinarily take twenty, the visits are worth most at the beginning, when the assessment, the technique correction and the loading decisions are hardest to get right alone.
Then hand over more of the programme. A well-taught home programme with a written progression, checked at intervals, does a great deal of the work — and for many conditions the supervised portion is about teaching and adjusting rather than about the exercise happening in our building.
Space the later visits further apart. Weekly for the first month, then fortnightly, then monthly, is frequently a better use of twelve visits than twelve consecutive weeks.
And say plainly where the cap will not stretch. Some courses genuinely need more visits than a plan allows — ACL reconstruction is the obvious one at thirty to fifty over a year — and in those cases the honest conversation is about what the self-pay portion would cost, held at the start rather than in month eight.
Where the pressure runs the other way
A visit cap also creates a temptation for a clinic: use the allowance because it is there. Twenty authorised visits is not a target, and a patient who is better at visit nine should be discharged at visit nine with eleven unused.
This is the same argument as the one against prepaid packages and it has the same answer. We publish the typical course length for every condition, we give you an estimate at the first appointment, and we reassess at visit four. None of those numbers are derived from what your insurer will pay for.
In order
How this works in practice
Give us your insurance details when you book
Ideally a few days ahead, so the check is done before your first appointment.
We verify the benefit
Visits allowed, visits used, copay or coinsurance, referral or authorisation requirements, and whether the pool is shared.
You get the number before you start
Plainly, and in time for it to be useful.
We plan the course around it
Front-load the supervised work, hand over more of the programme, and space the later visits.
We tell you if the cap will not stretch
With what the remainder would cost self-pay, at the start rather than in month eight.
We discharge when you are better
Not when the allowance runs out. An unused visit is not a wasted one.
Questions we are actually asked
Your plan's visit limit, and what we do about it — frequently asked
How many physical therapy visits does my insurance cover?
It varies enormously — typically twenty to sixty a year on a commercial plan, sometimes shared with occupational and speech therapy, sometimes subject to prior authorisation after a threshold. We verify it before your first visit and tell you the actual number for your plan rather than a generality.
What happens if I run out of covered visits?
We will have seen it coming and told you well beforehand. The options are usually to continue at the self-pay rate, to space visits further apart, or to move to a home programme with occasional review — and which is right depends on where you are in the course. What should not happen is discovering it at the desk.
Do you check my benefits before I come in?
Yes, as a matter of course. Visits allowed and used, copay or coinsurance, and whether a referral or authorisation is needed. A benefit check is a good-faith estimate rather than a guarantee, which insurers say themselves, but not doing one at all passes a risk to you that we are far better placed to carry.
Will you use up all my visits?
No. An authorised number is a ceiling, not a target. If you are better at visit nine of an authorised twenty, you are discharged at visit nine. The course length we plan comes from your condition and your measurements, not from what your insurer will pay for.
Are you in network with my plan?
We are in network with several major carriers. Telephone with your card and we will tell you where you stand in a few minutes, including what the out-of-network position would be if we are not — some plans reimburse a useful share of it and some reimburse nothing, and that is worth knowing before rather than after.
Sixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.