What Do I Need for Insurance To Cover Pelvic Floor Therapy?

Most health insurance plans should cover physical therapy for individuals experiencing pelvic floor dysfunction, although you may be required to receive a referral from your primary care physician (PCP) depending on the type of plan you have.

Keep reading to learn more about when and how pelvic floor therapy is covered by insurance along with what treatment entails and what symptoms it can help alleviate.

On This Page

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  What Is Pelvic Floor Therapy?

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  Is Pelvic Floor Therapy Covered by Insurance?

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  Should I Consider Paying Out of Pocket for Pelvic Floor Therapy?

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  How Do I Get an Appointment With a Pelvic Floor Therapist?

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  FAQs

What Is Pelvic Floor Therapy?

Pelvic floor therapy is a type of physical therapy aimed at addressing pelvic floor dysfunction. The pelvic floor consists of 26 muscles that serve various purposes such as supporting organs like the uterus and prostate, keeping your pelvis and spine stable, helping with sexual function and enabling you to control your bladder and bowel movements.^[1]

If these muscles aren’t working properly, then you could experience pelvic floor issues like incontinence, constipation, pain during sexual intercourse and bulging or herniation of pelvic organs.^[2] You may be at a higher risk for pelvic floor dysfunction if you are pregnant or have recently given birth and your risk may also increase as you get older.^[1]

How Does Pelvic Floor Therapy Work?

The purpose of pelvic floor therapy is to either strengthen or relax your pelvic floor muscles as necessary. You will generally begin with a consultation and medical exam with your pelvic physical therapist so they can figure out the treatment plan that is most likely to address your specific set of symptoms. Pelvic floor treatment may involve Kegel exercises and stretches, manual therapy, biofeedback and electrical stimulation.^[1]

Is Pelvic Floor Therapy Covered by Insurance?

Health insurance companies largely cover pelvic floor dysfunction treatments including pelvic floor therapy.^[3] If you already know that your plan covers other types of physical therapy, then you can generally expect it to cover pelvic floor therapy as well.

That said, coverage can vary from insurer to insurer and there may be restrictions or qualifications you must meet depending on the details of your plan.

For example, Medicare does not cover electric stimulation therapy for urinary incontinence unless you have already gone through pelvic muscle exercise training to no avail.^[4]

Do I Need To Pay a Copay for Every Pelvic Floor Therapy Session?

Marketplace health plans are only required to provide coverage without copays for screenings and other preventive services, meaning you may be charged a copay whenever you visit pelvic floor therapists covered by insurance.^[5]

Many health plans classify physical therapists as specialists, which means their services often require higher copays, potentially as high as $60 or more.^[6] In addition, you should note that you may have to pay the full price for pelvic floor therapy sessions covered by insurance until you reach your deductible for the year.

Should I Consider Paying Out of Pocket for Pelvic Floor Therapy?

The main reason you might want to pay for pelvic floor therapy out of pocket is if you want to see a specific specialist who isn’t in your health plan’s network. Some pelvic floor therapists don’t contract with any health insurance companies, which means you won’t receive any insurance coverage for their services if you have a health maintenance organization (HMO) or exclusive provider organization (EPO) plan that doesn’t cover out-of-network care.

The average price range for pelvic floor therapy is $100 to $250 per session and treatment often requires weekly sessions for four to 12 weeks.^[7] As a result, the overall cost of pelvic floor therapy may span from around $400 to $3,000 without health insurance depending on the severity of your condition.

How Do I Get an Appointment With a Pelvic Floor Therapist?

You may be able to research pelvic floor therapists online and book an appointment with one directly through their website or over the phone. Alternatively, you could consider asking your doctor for a recommendation. Since physical therapists are often considered specialists, you may need a referral from your PCP to see a pelvic floor therapist anyway if you have an HMO or point-of-service (POS) plan.