Frozen Shoulder Physiotherapy – Does My Insurance Cover It?

The unfortunate individuals dealing with adhesive capsulitis (also known as frozen shoulder) often choose frozen shoulder physical therapy as their treatment of choice. If the person has decent insurance, this is a wise choice, but since this condition has no economic limits, the patient often lacks adequate insurance and faces the possibility that their particular policy will not cover such services.

Historically, Medicare has always covered physical therapy services provided they are medically necessary. However, there is an ongoing battle going on in Congress over whether or not to stop physical therapy services after a certain amount of money has been paid. A limit is very restrictive because it usually includes other support services. This means that if someone has extensive medical problems, they may receive little or no therapy in the time they need it. In particular, frozen shoulder physical therapy requires multiple sessions of one-on-one joint mobilization to achieve functional range of motion.

Blue Cross Blue Shield insurance recipients are typically covered at a rate of 80/20 – that’s 80% insurance responsibility and 20% patient responsibility. However, it is increasingly common for some BCBS policies to limit outpatient therapy to a number of visits per year. Good luck if you have a particularly bad year with more than one injury or surgery that requires PT. As a healthcare recipient, make sure you do your due diligence on what your individual policy may cover in relation to therapy.

Individuals who injure their shoulder on the job may be covered by Workmans compensation. All employers with more than 5 employees are required by law to take out occupational accident insurance. This does not necessarily mean that the treatment of your injury is covered. The resulting injury and development of adhesive capsulitis should be documented as work related. Therefore, all work-related accidents or injuries must be reported to a supervisor who, as a first step, documents the dates and times of the occurrence. It’s also a good idea to keep your own log of dates and times, mileage, etc… if you get injured while doing your job.

Medicaid recipients should check with their provider to see if Medicaid is accepted. If so, talk directly with the therapist about how many units or allowances his or her plan of care needs. Medicaid limits certain costs to a finite number per year.

All in all, frozen shoulder physical therapy is covered in one way or another by most insurance plans, but each individual will have to do a little research to make sure they are covered and don’t end up with out-of-pocket expenses. .