Have you ever heard of pelvic floor therapy but weren’t sure if insurance covers it? You’re not alone. Many people wonder if this helpful treatment is part of their health insurance plan.
Pelvic floor therapy is a type of physical therapy. It helps when muscles in the lower belly, hips, or groin don’t work right. People use it to treat things like pain, bladder leaks, or trouble going to the bathroom.
But here’s the big question: Is pelvic floor therapy covered by insurance? In this guide, we’ll break it down in a simple way. You’ll learn how coverage works, what to ask your insurance company, and what to do if it’s not covered.
Let’s get started.
What Is Pelvic Floor Therapy and Why Do People Need It?
Your pelvic floor is a group of muscles at the bottom of your belly. These muscles support your bladder, bowels, and — for women — the uterus. When these muscles are too tight or too weak, problems can happen.
That’s where pelvic floor therapy comes in. It’s a kind of physical therapy that helps fix how these muscles work. Many people need it when they feel pain, leak pee, or have trouble going to the bathroom. Others get it to improve strength after childbirth or surgery.
Pelvic floor therapy helps your body work better and feel better. Let’s look at the problems it can help with.
Common Conditions It Helps With
Incontinence: This means leaking pee or poop when you don’t want to. It can happen when you laugh, sneeze, or run. Pelvic floor therapy helps by making the muscles stronger so you can stay dry and in control.
Pelvic Pain: Some people feel a dull or sharp pain in the lower belly or between the hips. This pain can come from tight or weak pelvic muscles. Therapy can help relax or balance these muscles.
Sexual Issues: For some people, pelvic floor problems can make sex painful or less enjoyable. By improving muscle control and reducing tension, therapy can help make things more comfortable.
How the Therapy Works
Muscle Training: Your therapist will teach you how to squeeze and relax the right muscles. You’ll learn exercises like Kegels, which help build strength and control. Over time, this can stop leaks and reduce pain.
Manual Techniques: Sometimes, the therapist may use gentle hands-on methods to help tight muscles relax. They might press or stretch certain areas to improve movement and blood flow. This can ease pain and help the muscles work the way they should.
At-Home Exercises: You’ll also get simple workouts to do at home. These might include breathing, stretching, or posture work. Doing them every day helps your progress last longer and work better.
Does Insurance Cover Pelvic Floor Therapy?
Many people ask, “Is pelvic floor therapy covered by insurance?” The answer is—it depends. Some insurance plans pay for it, while others do not.
Whether or not your therapy is covered depends on a few things. These include your doctor’s notes, your insurance company’s rules, and even who your therapist is.
Let’s go over when insurance might cover this treatment and what you need to check.
When Is It Usually Covered?
Requires a Doctor’s Referral
Most insurance companies want proof that you need pelvic floor therapy. They may ask for a note or referral from your doctor.
This referral tells the insurance company that a medical expert says the therapy is needed for your health.
Must Be “Medically Necessary”
The term “medically necessary” means the treatment is needed to fix a real health problem. If you have bladder leaks, pelvic pain, or other related issues, your doctor can help prove it’s necessary.
If insurance doesn’t think the therapy is needed, they might not pay for it. So having a diagnosis helps.
Which Insurance Plans Might Cover It?
Private Insurance (Like Blue Cross, Aetna, etc.)
Many private insurance plans do cover pelvic floor therapy. But they all have different rules. Some may limit how many visits you get.
Always call your insurance company to ask what’s covered under your plan.
Medicaid and Medicare
Medicaid and Medicare may cover therapy if your doctor says it’s needed. But you usually need to see an approved therapist who accepts these plans.
Coverage can also depend on your state and age, so double-check your plan.
Employer-Sponsored Plans
If you get insurance through work, you may have good coverage. But even these plans may ask for a referral or limit the number of visits.
Ask your HR department or insurance provider for details.
What Can Affect Coverage?
Your Diagnosis
Insurance companies look at your medical diagnosis to decide if therapy is needed. For example, if your doctor says you have urinary incontinence or pelvic pain, you’re more likely to get coverage.
If there’s no clear reason for therapy, your plan might not pay.
Therapist’s Credentials
Not every physical therapist is trained in pelvic floor therapy. Insurance companies often require treatment from a licensed and qualified provider.
Make sure your therapist is certified and approved by your insurance network.
In-Network vs Out-of-Network
“In-network” means the therapist works with your insurance company. Seeing an in-network provider usually costs less out of your pocket.
If your therapist is out-of-network, you may pay more, or the treatment might not be covered at all.
How to Check If Your Insurance Covers Pelvic Floor Therapy
Before starting pelvic floor therapy, it’s smart to know what your insurance will pay for. Some plans cover everything, while others don’t cover it at all.
You don’t want any surprise bills. So, take time to ask the right questions. Let’s look at simple steps to help you check your coverage.
Steps to Follow
Call Your Insurance Provider
Start by calling the number on the back of your insurance card. Ask them, “Does my plan cover pelvic floor physical therapy?”
Give them your therapist’s name and clinic, if you have one. They can tell you if they are in-network or out-of-network.
Ask About Deductibles and Session Limits
Even if therapy is covered, you might have to meet a deductible first. A deductible is the amount you pay before insurance helps.
Also, ask how many visits are allowed per year. Some plans limit you to just a few sessions.
Get a Written Estimate or Pre-Authorization
Ask your insurance provider for a written estimate of your costs. You can also request a pre-authorization, which is approval before starting therapy.
Having this in writing protects you in case of billing issues later.
What to Ask Your Therapist’s Office
Do They Accept Your Insurance?
Call the clinic where you want to go. Ask, “Do you take my insurance plan?” They’ll check if they are in-network or out-of-network for you.
Going in-network usually saves you money.
Can They Provide a Superbill?
If the clinic doesn’t take your insurance, ask for a superbill. This is a special receipt that you send to your insurance company.
Sometimes, your insurance will pay you back after you submit the superbill.
What If Pelvic Floor Therapy Is Not Covered?
Sometimes, insurance won’t pay for pelvic floor therapy. This can feel frustrating, but don’t worry—there are still ways to get the help you need.
You can pay on your own (called out-of-pocket), or use special savings accounts made for health care. Let’s look at your choices.
Paying Out-of-Pocket Options
Typical Session Costs
The cost of one session depends on where you live and the clinic you visit. Most sessions cost between $75 and $200.
Some therapists charge more if they have extra training or use special tools.
Package Deals or Sliding Scales
Some clinics offer package deals, where you pay less per session by buying a group of visits. Others use a sliding scale, which means the price depends on how much money you make.
Always ask if the clinic offers discounts or payment plans.
Using HSAs or FSAs to Pay
How to Use These Accounts
If you have an HSA (Health Savings Account) or FSA (Flexible Spending Account), you can use that money. These accounts let you pay for therapy with pre-tax dollars, which saves you money.
Just make sure your plan counts pelvic floor therapy as a qualified expense. Most do, but it’s smart to double-check.
What Receipts or Documents You Need
To use HSA or FSA money, keep all receipts and invoices from the clinic. You may also need a doctor’s note saying the therapy is medically needed.
These documents help if your plan asks for proof later on.
Conclusion
Pelvic floor therapy helps people feel better. It’s great for bladder leaks, pelvic pain, and other private issues.
Sometimes, insurance pays for it. But not always. That’s why it’s smart to check your coverage before you begin treatment.
If your plan doesn’t cover it, don’t give up. You can ask about payment plans, use HSA or FSA accounts, or try discount packages.
The most important thing? Get the care your body needs. Relief is possible—and you have options to make it happen.
Dr. Michael Hartman, DPT, is a skilled physical therapist with 15+ years of experience in rehab and pain management. He specializes in musculoskeletal and pelvic health therapy, using evidence-based, personalized care. Dr. Hartman is passionate about helping patients move better, feel stronger, and live pain-free.
