Is Pelvic Floor Therapy Covered by Insurance?
Pelvic floor therapy may be covered by insurance, but coverage depends on your specific plan, diagnosis, and whether your provider is in-network. Many patients discover that even when insurance is accepted, visit limits, denied diagnosis codes, or rushed care affect access and results. This article explains how pelvic floor physical therapy is billed, why coverage varies, what out-of-network care means, and how to find out your benefits. It also outlines why many patients choose one-on-one pelvic floor PT and how Envision Pelvic Health & Wellness supports patients with transparent pricing and guidance in Northwest Chicago near Park Ridge, IL.
This is one of the most common questions I hear as a pelvic floor physical therapist and one of the most searched questions online.
After working in pelvic health for over nine years, I have learned that many people feel confused and frustrated when it comes to insurance. Patients are often unsure what is covered, what is not, or what they can expect to pay out of pocket.
This confusion is understandable. Insurance plans are complex, coverage varies by plan, and policies change often. In recent years, some insurance companies have stopped covering certain pelvic health diagnosis codes altogether, which has created even more confusion for patients and providers.
Another reason this question comes up so often is that many pelvic floor physical therapists have chosen to open independent practices and work as out-of-network providers.
If you are asking, “Is pelvic floor therapy covered by insurance?” the most honest answer is: it depends. The good news is that you have options, and this article will help you understand them so you can make the best decision for your care.
What Is Pelvic Floor Therapy?
Pelvic floor physical therapy is a specialty within physical therapy that focuses on the muscles, nerves, and connective tissues of the pelvis.
What conditions does pelvic floor therapy treat?
Pelvic floor therapy can help with:
Constipation or bowel dysfunction
Pelvic pain or pressure
Core and hip dysfunction related to the pelvis
The pelvic floor muscles sit inside the pelvis and support the bladder, bowel, and reproductive organs. Because these concerns are personal and often sensitive, pelvic floor physical therapists complete additional training after their doctoral degree.
This type of care requires privacy, time, and a safe environment. Unfortunately, not all physical therapy clinic models allow for this. Some clinics double book therapists or treat patients in open gym spaces without private rooms, which can make it difficult for patients to feel comfortable sharing personal details.
This mismatch between the needs of pelvic health care and traditional insurance-based clinic models plays a large role in why insurance coverage can be inconsistent.
Is Pelvic Floor Therapy Covered by Insurance?
The short answer is sometimes, but it depends.
Pelvic floor therapy can be covered by insurance, but coverage is not guaranteed. Even two people with the same insurance company may have very different benefits.
Factors that affect insurance coverage
Several factors influence whether pelvic floor therapy is covered:
Your insurance plan
Each plan has its own rules regarding deductibles, co-pays, and annual visit limits. Some plans offer strong physical therapy benefits, while others are very limited.Provider network status
Insurance coverage often depends on whether your pelvic floor therapist is in-network or out-of-network. In-network providers may be covered at a higher rate, while out-of-network care often requires upfront payment with the option for reimbursement.Diagnosis codes
Pelvic floor therapy is billed as physical therapy, but the diagnosis attached to the visit matters. Some diagnoses are more likely to be approved than others, and coverage can change based on how services are classified.Visit limits and authorization requirements
Many insurance plans cap the number of physical therapy visits per year or require prior authorization. This can limit how much care is covered, even when benefits exist.
Because pelvic health is still an under recognized specialty, coverage policies can be inconsistent and confusing. It is best to think of insurance coverage as nuanced rather than a simple yes or no.
Why Insurance Coverage for Pelvic Floor Therapy Varies
Not all pelvic floor therapists are in-network
Pelvic physical therapy is a growing field, but pelvic floor therapists still make up a small percentage of all physical therapists. The number of people who need pelvic floor therapy is much greater than the number of trained providers.
Many pelvic floor therapists choose to work out-of-network so they can:
Provide one-on-one care
Spend adequate time with patients
Avoid restrictive insurance rules
Insurance companies often place limits on visit length and treatment approaches, which makes it difficult to deliver high quality pelvic health care.
Visit limits and diagnosis restrictions
Insurance plans often place annual caps on physical therapy visits. Some plans allow as few as 12 visits per year, while others allow more.
Insurance companies may also deny coverage based on diagnosis codes. For example, some plans have recently restricted or denied coverage for diagnoses such as pelvic floor dysfunction, prolapse, or certain pelvic pain codes. This means that even if your provider accepts your insurance, visits may still be denied.
Time and quality of care
Pelvic floor therapy requires privacy, trust, and time. Many insurance-based clinics rely on double booking therapists or using aides to make ends meet as reimbursement rates decline.
This is one of the main reasons many pelvic floor therapists choose an out-of-network model. It allows them to prioritize quality of care over volume.
What Does Out-of-Network Pelvic Floor Therapy Mean?
When a pelvic floor physical therapy clinic is out-of-network, it means the clinic does not have a direct contract with your insurance company. Care is still provided by a licensed physical therapist, but insurance is not billed on your behalf.
What this looks like for patients
With out-of-network pelvic floor therapy:
Patients pay at the time of service
Care is not limited by insurance rules
One on one sessions are possible
Most out-of-network clinics provide a superbill after each visit. A superbill is a detailed receipt that you can submit to your insurance company for possible reimbursement.
Reimbursement varies by plan. Some patients receive partial reimbursement, some receive credit toward their deductible, and some plans do not reimburse at all.
At Envision Pelvic Health & Wellness, our out-of-network model allows us to offer one-on-one, 60 minute pelvic floor PT sessions without rushing or double booking patients.
Can I Get Reimbursed for Pelvic Floor Therapy If It Is Out-of-Network?
Possibly. Every insurance plan is different.
How reimbursement usually works
The process often looks like this:
You attend your session and pay at the time of service
You receive a superbill from the clinic
You submit the superbill to your insurance company
A superbill includes:
Patient information
Provider credentials and license number
Diagnosis and treatment codes
Cost of services
Most plans require you to meet your out-of-network deductible before reimbursement begins. After that, some plans reimburse a percentage of the visit.
Pelvic floor therapy is also commonly eligible for HSA and FSA funds.
Why Some Patients Choose Out-of-Network Pelvic Floor PT Anyway
Many patients seek out-of-network care after long wait times or limited results in traditional settings.
Common reasons patients choose out-of-network pelvic floor therapy include:
Specialized pelvic floor therapists
One-on-one appointments
Longer sessions
Faster access to care
Personalized treatment plans
For some patients, out-of-network care is more cost effective depending on their insurance benefits.
How Much Does Pelvic Floor Therapy Cost Without Insurance?
The cost of pelvic floor therapy without insurance varies by provider, location, and session length.
Questions to ask before starting care
Before beginning treatment, ask:
Cost per session
Length of visits
Whether care is one-on-one
Frequency of visits
Expected plan of care
Payment methods accepted
At Envision Pelvic Health & Wellness, we believe in transparent pricing so patients know what to expect. You can find out more about our payment and reimbursement method here.
How We Approach Insurance at Envision Pelvic Health & Wellness
At Envision Pelvic Health & Wellness, we believe patients deserve clarity, choice, and high-quality care.
We operate as an out-of-network pelvic floor physical therapy clinic so we can provide:
One-on-one, 60-minute sessions
Private treatment rooms
Individualized care plans
Superbills for reimbursement
We prioritize open conversations upfront, so patients understand their options before starting care. We also support patients in using out of network benefits, HSA or FSA funds, or choosing the care model that fits their needs.
As a provider of pelvic floor PT in Northwest Chicago, near Park Ridge IL, we are proud to offer patient centered care focused on quality and outcomes. You can learn more about our “why” for creating Envision Pelvic Health & Wellness here.
How to Find Out If Your Insurance Covers Pelvic Floor Therapy
Because coverage varies widely, the best way to get clear answers is to contact your insurance company directly.
Insurance coverage checklist
When you call your insurance company, ask:
What are my physical therapy benefits?
Do I have out-of -network PT coverage?
Are there visit limits?
Is prior authorization required?
What percentage is reimbursed?
Does this apply to my deductible or out of pocket maximum?
Also ask the clinic:
Do you provide superbills?
What diagnosis and treatment codes are used?
Final Thoughts: Do Not Let Insurance Be the Only Factor in Your Care
Pelvic floor symptoms are real, common, and treatable. While insurance coverage is important, the quality of care matters.
If pelvic floor therapy is not fully covered by your insurance, that does not mean care is out of reach. Many patients successfully use out-of-network benefits, HSA or FSA funds, or choose a care model that prioritizes individualized treatment.
Your body and well-being are worth investing in.
Ready to Take the Next Step?
If you have questions about insurance, cost, or whether pelvic floor therapy is right for you, we are here to help.
You are welcome to:
Book a discovery call
Call the clinic with insurance questions
Learn more about our pelvic floor therapy services
If you are looking for pelvic floor PT in Northwest Chicago, near Park Ridge IL, Envision Pelvic Health & Wellness is here to support you with transparent guidance and compassionate care.
Book a discovery call or submit a contact form today.
Or, if you’re ready to book your initial evaluation use the link below.