Physiotherapy is recommended by doctors for various conditions related to muscles, bones, joints, ligaments, and tendons. This includes conditions like arthritis, back pain, sprains, and strains.
Physiotherapy helps patients recover and regain mobility after surgeries, such as joint replacements or orthopedic procedures.
Apart form these physiotherapy is also prescribed in various other cases like sports injury, neurological disorders, chronic pain management, rehabilitation after accident. It helps in improving muscle movement, coordination and regaining strength.
Physiotherapy prescription types
Physiotherapy can be prescribed by doctor in 2 conditions:
Condition 1: Post hospitalisation
This comes under post surgery rehabilitation part of treatment. Where patient got admitted in a hospital for some surgical/medical intervention and doctor recommended physiotherapy for some weeks after discharge from hospital.
Condition 2: OPD basis
When patient consulted the doctor for some issue and doctor prescribed few sessions of physiotherapy. Here patient was not admitted in hospital but physiotherapy is only prescribed on OPD basis.
OPD is basically an abbreviation for out patient department.
An Out-Patient Department refers to the section of a hospital where patients receive medical treatment without being admitted overnight. OPD services include consultations with doctors, diagnostic tests, physiotherapy, minor procedures, and medications, all of which are provided on an outpatient basis.
Physiotherapy coverage under health insurance
Coverage for condition 1: post hospitalisation expenses
Standard Health insurance policy that doesn’t have OPD coverage, covers physiotherapy only under condition 1 that is if it has been prescribed by doctor as a part of rehabilitation, after discharge from hospital.
Here it is important to note that if policy has any limit on post hospitalisation expenses, the same become applicable for physiotherapy also and expenses are payable up to that limit only.
Doctor prescription is must for admissibility of claim. Physiotherapy expenses without doctor recommendation are not payable.
If a policy doesn’t cover post hospitalisation expenses then these charges are not payable under that policy. However, such polices are very few and rare. Normally, health policies cover minimum 30 days of pre hospitalisation expenses and 60 days of post hospitalisation expenses.
Coverage for condition 2: OPD basis physiotherapy
Standard health insurance policies generally do not have coverage for OPD. Only comprehensive health insurance policies cover OPD expenses that too up to certain limit like 20k/30k per policy period.
Therefore, policies that have OPD coverage, pay physiotherapy expenses up to the OPD cover limit, where physiotherapy has been prescribed by doctor on OPD basis only.
Here it is important to check the limits on OPD coverage. In some health insurance policy OPD coverage is also very specific like for ophthalmic and dental treatment only.
Therefor, physiotherapy expense on OPD basis are strictly as per OPD terms and conditions of policy.
Final take
I hope you are now clear, how and under what conditions physiotherapy is covered under health insurance policy.
As a policyholder you must be aware of coverages under your health insurance policy. There are always few cases where Insurance companies deny physiotherapy claims as post hospitalisation expenses. While the claim is payable as the policy has post hospitalisation cover and doctor has recommended the physiotherapy. In these cases policyholder must challenge the insurance company and raise grievances at appropriate forms like grievance cell of insurance company and IRDA.
