If you’re considering pelvic floor therapy & have Blue Cross Blue Shield (BCBS) insurance, you’re likely wondering if your plan will cover it. The good news is that many BCBS plans do cover pelvic floor physical therapy, but there are a few important details to understand.

Understanding What’s Covered

Pelvic floor therapy is usually included in your outpatient physical therapy benefits. Most BCBS plans consider this treatment medically necessary when it addresses conditions like urinary incontinence, pelvic pain, prolapse, or postpartum recovery. Because of this, coverage is often available, as long as you meet your plan’s specific requirements.

What You’ll Likely Need

To maximize your benefits & avoid unexpected costs, here’s what you should have in place…

• Medical Diagnosis – Your condition must be documented & considered medically necessary.

• Referral from a Physician – Many plans require a referral from your primary care doctor or OB-GYN.

• Preauthorization – Some policies need prior approval before treatment begins.

By preparing these in advance, you’ll improve your chances of full or partial coverage.

Are There Any Exclusions?

While most core treatments are covered, some specialized therapies, like electrical stimulation, may not be reimbursed under all plans. For example, BCBS of North Carolina does not cover electrical stimulation for pelvic floor dysfunction unless certain strict criteria are met. This is why it’s crucial to read your plan documents carefully or speak directly with a representative.

Next Steps to Confirm Coverage

• Log in to your BCBS member portal to review benefits.

• Call customer service (you’ll find the number on your insurance card).

• Ask specific questions, such as…

  • Is pelvic floor therapy covered under my outpatient benefits?

  • Do I need a referral or prior authorization?

  • What’s my copay or coinsurance?

  • Are there visit limits?

Blue Cross Blue Shield often covers pelvic floor therapy, but the exact terms depend on your individual plan. By taking a few proactive steps, like getting a referral, confirming medical necessity, & choosing an in-network provider, you can ensure you receive the benefits you’re entitled to. Always double-check with your provider and BCBS directly to avoid surprises.