Does Medicaid Cover Pelvic Floor Therapy?
Pelvic Floor Therapy (also known as pelvic floor physical therapy, pelvic floor PT, pelvic health occupational therapy or, womb healing bodywork) is a dynamic and holistic approach to addressing pelvic health concerns. Pelvic floor muscle tension, pelvic congestion, nervous system dysregulation, maladaptive posture, and maladaptive breathing patterns are some of the common factors that contribute to pelvic floor dysfunction. Urinary frequency, urinary urgency with or without leaking, leaking urine with sneezing/coughing/laughing, chronic constipation, fecal incontinence, feeling of incomplete emptying, and pelvic pain during or after sex are some common ways pelvic floor dysfunction negatively impacts daily life. Pelvic Floor Therapy is a specialty area of Physical Therapy (PT) and Occupational Therapy (OT). In the same way that you would go see a physical therapist for rehabilitation after a joint replacement or an occupational therapist to address your child’s sensory integration needs, you can go see a PT or an OT specializing in pelvic floor therapy to address functional concerns related to your pelvis.
Who Can Benefit From Pelvic Floor Therapy?
The short answer? Anyone…everyone! It happens quite frequently that a client will share astonishment that the first time they are learning foundational skills in breathing and posture is during our plan of care. “Why didn’t I learn this in school?” and “This would have been helpful to learn when I was growing up” are some common reflections during pelvic floor education and training.
Anyone living in any type of body who has pelvic health concerns will benefit from consulting with a pelvic floor therapist. This includes all gender identities, nulliparous people, perinatal people, children, older adults, and people with disabilities. If you have a pelvis and concerns about how it’s functioning, pelvic floor therapy is a great place to start. Although pelvic floor therapy is most readily considered during postpartum care, anybody with pelvic health concerns can benefit from working with a pelvic floor therapist. Painful periods, pain with sex, bowel and bladder incontinence, sporadic shooting pelvic pain, and low back pain are common issues that pelvic floor therapists address.
It’s never too early to start pelvic floor therapy. It can take up to eight years for clients with pelvic health concerns to seek treatment according to the NIH. Oftentimes, when I start digging into the client’s history, initial symptoms of pelvic floor dysfunction can date back to as early as childhood.
It’s also never too late for pelvic floor therapy. It’s socialized that peeing your pants is normal after childbirth. Although it’s all too common, this is not normal physiological functioning. Oftentimes mothers who have been dealing with this dysfunction for months, years, and even decades ask if it’s too late to try pelvic floor therapy. I’ve helped people who have been dealing with peeing their pants for a long time achieve meaningful rehabilitation outcomes within a few sessions.
People are also often surprised to hear that I work with men. Yes, men have pelvic floors too and I consider it a social justice issue to increase awareness and accessibility to pelvic floor therapy for people with penises. Some common concerns I address include difficulty initiating or controlling bladder, constipation, rectal pain, and pain during or after sex/ejaculation. Barriers to care for penis-bodied people include a female-dominated rehabilitation field where many clinicians only provide services for women’s health, decreased awareness of pelvic floor dysfunction for this population, and increased embarrassment that prevents individuals from seeking professional help.
Does Medicaid Cover Pelvic Floor Therapy?
The simplified answer is yes, Medicaid does in fact cover pelvic floor physical therapy and occupational therapy. Members enrolled in most Medicaid plans are eligible to receive outpatient PT/OT services that are deemed medically necessary. This means that a prescribing provider must sign a referral for outpatient PT/OT in addition to a plan of care written by the licensed PT or OT. A prescribing provider is someone who can prescribe you medication such as MDs, NPs, PAs, DOs, and CNMs. In addition to prescribing medications these providers also provide referrals for other healthcare services such as lab work, and specialty referrals and oversee plans of care for rehabilitation therapies.
Pelvic floor therapy is a specialty area of physical therapy and occupational therapy is most often is administered within the outpatient level of care. Medicaid covers outpatient occupational therapy and physical therapy services. Outpatient rehabilitation therapy is a level of care for people who are accessing healthcare while living in the community, as opposed to higher levels of care such as being admitted to the hospital or temporarily living in a rehabilitation center.
Although Medicaid does cover pelvic floor therapy, many pelvic floor specialists are not enrolled with Medicaid or other insurance providers. To my understanding, even if people with Medicaid coverage wanted to privately pay for cash-based providers, it is considered unlawful for these therapists to accept cash from people with Medicaid. This creates limited choice for people with Medicaid to only work with providers enrolled to bill medicaid, which significantly limits options. In the same way that you may be discerning about which psychotherapist feels like the right fit, you may want to explore your options to find the pelvic floor therapist with whom you are excited to work with.
Understanding Eligibility for Medicaid Coverage
You can check your eligibility for Colorado Medicaid coverage by applying through the Heath First Colorado website if you meet their qualifying income criteria.
If you have Medicaid in addition to private insurance, then the visit must be submitted to private insurance first. The private insurance may cover anywhere from nothing to the full payout of the visit. Once the private insurance coverage amount is determined, the remainder of the balance can be submitted to Medicaid for full coverage. This process is completed by Liberate Pelvic Health.
Do Other Insurances Cover Pelvic Floor Therapy?
Many private insurance companies cover some amount of rehabilitation therapies. Copays and amounts of visits vary greatly depending on how comprehensive the contracted plan is.
Larger outpatient clinics with robust billing departments are your best bet for directly billing major insurance providers. These larger clinics can be a great place to start. In the same way that finding the right fit for a talk therapy provider, you may be more comfortable with some pelvic floor therapists than others. Further, on a pelvic healing journey, you may get to a certain point of healing with one provider and then benefit from taking the next step with a different provider once you plateau or no longer want to work with someone. If resources are limited, then starting with a larger outpatient clinic that has pelvic floor therapy services may be a great place to start. However keep in mind that if you only get so far with that avenue, expanding your search to find a pelvic floor therapist who resonates more deeply with your healing journey and can provide more personalized services may be a valuable next step in your healing journey.
Alternatives for Accessing Pelvic Health Services Without Insurance
Colorado is a Direct Access state, meaning physical and occupational therapists can provide services without being referred and overseen by a prescribing provider. However, to directly bill health insurance, obtaining a referral and signed plan of care is a required process. If a rehab therapist is not directly billing through insurance, then most therapists will collect payment upfront and offer superbill receipts for the client to directly submit to their insurance. If a client’s plan has out-of-network benefits, then there is a good chance of being reimbursed for partial or full coverage of out-of-network pelvic floor therapy visits.
Since pelvic floor physical therapy and pelvic floor occupational therapy are emerging specialty areas for these rehab professions, there is a high demand for providers skilled in this area. Oftentimes when providers are in private practice, they are able to sustain a successful cash-based practice without navigating the complex insurance reimbursement process due to the high demand for this skillset.
Through May 2025 Liberate Pelvic Health has scholarship sessions available for black birthing Colorado residents who are uninsured, privately insured, or have medicaid coverage that is not Health First. Liberate Pelvic Health is so grateful to be a recipient of the Black Birthing Mental Health Community Investment grant through Colorado Access, as it affords the opportunity to provide pelvic floor therapy services for black birthing people who may not otherwise have access to pelvic floor therapy due to health inequities caused by racism. Liberate Pelvic Health welcomes collaboration for additional funding to support the ongoing sustainability of this scholarship program; please reach out through the contacts tab if you have ideas or leads for future funding.
Taking The Next Steps at Liberate Pelvic Health
If you feel aligned with Liberate Pelvic Health, please take the first step by contacting us for a free informational call to address your pelvic health concerns. At the time this blog is being written, Liberate Pelvic Health is in network with Health First Colorado Medicaid Plan and is currently in the process of becoming in network with CHP+ Medicaid Plan. Superbills for privately insured clients are also available upon request for clients who want to submit for reimbursement for out-of-network rehab therapy services. Unfortunately, Medicaid Choice (Denver Health’s Medicaid HMO) and Emergency Medicaid and Reproductive Health Program are not available to Liberate Pelvic Health at this time. I welcome the opportunity to collaborate to improve the inclusivity and breadth of access for clients with all forms of Medicaid to anyone who can help me become in network with these subsidiary plans.
I hope this blog has helped to shed some light on utilizing your medicaid insurance to support your pelvic health concerns. Thanks for coming to my website and good on you for informing yourself regarding resources for improving your pelvic health and wellbeing.
