What is Physiotherapy?
Physiotherapy is a type of therapy that can help patients restore their movements, strength, and flexibility after suffering from an accident, surgery, disease, or any other illness. This form of therapy is normally recommended by doctors after illnesses such as fractures, joint replacement surgery, sports injuries, stroke, or back and neck problems.
What are the types of Physiotherapy Covered by Health Insurance?
Physiotherapy treatments covered by health insurance include the following, among others:
Neurological physiotherapy: Includes stroke, Parkinson's disease, and spinal cord injury.
Orthopedic physiotherapy: Includes fractures, anterior cruciate ligament tears, and surgical rehabilitation.
Pediatric physiotherapy: Includes developmental disorders and congenital abnormalities.
Geriatric physiotherapy: Includes problems associated with ageing and osteoporosis.
What Physiotherapy Treatments Are Covered by Health Insurance?
Physiotherapy can be covered by your health insurance, but only in certain situations and conditions. What's usually covered include:
Physiotherapy during hospitalisation: In the case where you get admitted due to an accident, surgery, or any other critical illness that includes physiotherapy in the recovery process, the expenses are generally covered by your inpatient treatment. Examples include recovery from bone fractures, joint replacement, and stroke cases.
Sessions after discharge from hospital: Most insurance companies cover the physiotherapy services that you require after discharge up to a certain number of days. It is because it falls within the post-hospitalisation period defined in your policy, usually between 60-90 days.
OPD physiotherapy (only if your plan has OPD cover): If your plan includes OPD (outpatient) benefits, physiotherapy done without hospital admission may be reimbursed.
When is Physiotherapy Not Covered By Health Insurance?
Physiotherapy is generally excluded in the following situations, even if the sessions are genuine and helpful.
Wellness, fitness, or preventive sessions with no diagnosed medical condition behind them.
Standalone OPD physiotherapy when your health plan has no OPD or day-care benefit.
Sessions related to an underlying medical condition, which is either excluded or within the waiting period. For example, some pre-existing musculoskeletal conditions may occur during the waiting period.
Sessions not having a valid prescription or medical documentation.
Non-medical sessions, such as cosmetic and lifestyle treatments, and those named exclusions in your policy.
Note: Exclusions and waiting periods may vary among insurance companies, even within two policies from the same company.
Inpatient vs Outpatient Physiotherapy Coverage: What is the Difference
The table below shows how these three common routes are treated.
| How physiotherapy is delivered | How it is usually treated | When it is paid |
|---|---|---|
| During hospital admission (in-patient) | Part of the hospitalisation bill | Paid within your sum insured, if the admission itself is admissible |
| As a day-care or domiciliary treatment at home under medical advice | Day-care or domiciliary hospitalisation, if the policy lists it | Paid only if the plan specifically covers day-care/domiciliary and conditions are met |
| Standalone clinic visits with no hospitalisation (out-patient) | OPD treatment | Paid only if your plan includes an OPD benefit or rider |
Find out how inpatient and outpatient hospitalisation differ in health insurance.
Review the post-hospitalisation time frame
Most insurance providers pay for costs incurred as follow-up procedures for a set number of days following discharge from the hospital (typically 60-90 days), provided that they have direct linkage with the hospitalisation. Always retain the prescription from the doctor as well as all the bills to claim these as post-hospitalisation expenses.
How to Claim Physiotherapy Expenses Under Health Insurance
The claim procedure will depend on whether or not the physiotherapy treatment is included in the hospitalisation bill or is an extra cost.
1. Get a Prescription in Writing: The doctor should give you a prescription for physiotherapy treatment along with the diagnosis of the ailment.
2. Keep All Papers: You must keep a record of the prescription, the bills for the sessions, and also any other documents that prove your illness.
3. Check What Your Policy Covers: Before you file a claim, find out whether your physiotherapy is covered as inpatient treatment, post-hospitalisation care, or OPD treatment. This will help you understand how your claim will be processed.
4. Send the Documents to Your Insurer: If you paid for the physiotherapy yourself, you'll need to apply for reimbursement. Fill in the claim form along with the required documents, such as your doctor's prescription, medical reports, bills, and payment receipts.
5. Wait for the Claim to Be Reviewed: After your insurer receives the claim, they'll go through the documents and may contact you if they need anything else.
Learn more about pre-hospitalisation and post-hospitalisation expenses in health insurance.
Key Takeaways
Health insurance usually covers physiotherapy when it's prescribed by a doctor as part of the treatment for a covered illness or injury.
Physiotherapy received during hospitalisation is generally included in your hospital bill.
Physiotherapy taken at a clinic is usually covered only if your policy includes OPD benefits.
If your doctor recommends physiotherapy after you're discharged, the sessions may be covered as post-hospitalisation expenses if they fall within the period allowed by your policy.
Fitness or wellness sessions, non-prescribed physiotherapy sessions, and treatment of non-covered diseases and waiting periods will not be covered.
A physiotherapy reimbursement claim requires a medical prescription, a bill, and diagnostic reports.
Frequently asked questions
This will depend on the type of delivery of physiotherapy services. Physiotherapy given while you are admitted is inpatient treatment, while sessions taken at a clinic without admission are considered outpatient (OPD) treatment.
Home physiotherapy may be paid under a domiciliary hospitalisation benefit if your policy includes it and the medical conditions for domiciliary treatment are met, such as the patient being unable to be moved to a hospital. Otherwise, it is treated like OPD care.
It depends on your policy. Some health insurance plans limit the number of physiotherapy sessions or the amount they'll pay for rehabilitation, while others cover the cost within the overall sum insured.
Yes, a prescription is required to claim coverage for physiotherapy, as the treatment is considered medically necessary for reimbursement by insurance companies.
Yes, you may, but not before the end of the waiting period for that particular pre-existing condition.
Sources and references
- 1.Insurance Regulatory and Development Authority of India (IRDAI) health insurance regulations and standard policy definitionsRegulator guidance on inpatient, day-care, domiciliary, and OPD treatment definitions
About the authors
Neviya Laishram
Written by · Senior Editor – Health, Life and Group Health Insurance Content at ACKOWith a journalism background, she brings 9 years of experience in strategising and editing health, life, and group health insurance content. Having written for magazines and digital publications, she combines research and editorial expertise to create credible, useful content for readers.
Dr Nitin Kumar Gupta
Reviewed by · SVP – Health Underwriting & Claims at ACKO General InsuranceWith 20+ years of experience in digital transformation and growth, he is a leader specialising in health, life, accident, and disability insurance. Backed by an MBBS degree and insurance designations (FLMI, FALU, FLHC, ACS, ARA), he combines expertise with leadership.
