Insurance We Accept for Physical Therapy | Lake Erie Physical Therapy

Type your insurance plan

Nothing you type leaves this page. Plans and benefits vary, so we confirm your coverage before your first visit.

Plans at a glance

Highmark Blue Cross Blue Shield	Accepted
Independent Health	Accepted
Univera Healthcare	Accepted
Aetna	Accepted
UnitedHealthcare	Accepted
Fidelis Care	Accepted
Molina Healthcare	Accepted
The Empire Plan	Accepted
Tricare	Accepted
Medicare	Accepted
Workers' Compensation	Accepted
No-Fault (auto accident)	Accepted
Cigna	Out-of-network
Railroad Medicare	Not accepted
Humana	Out-of-network
Medicaid managed care plans	Accepted
Medicaid	Depends on your card
Straight Medicaid (fee-for-service)	Not accepted

Are physical therapists covered by insurance? Usually, yes, but the details depend on your plan. Each insurer decides whether you need a referral or prior approval, how many visits you get in a year, and what you pay at each visit. Lake Erie Physical Therapy works with the plans below at our Buffalo clinic on Virginia Street. Networks change, so treat this list as a starting point and confirm with us when you call (716) 332-4838.

Plans we accept (please confirm with us)

Highmark Blue Cross Blue Shield. One exception: we are not a provider for TheraMatrix. If a company called TheraMatrix manages your physical therapy benefit, call us before you book.
Independent Health. Its Medicare plans require prior authorization for physical therapy. See the Medicare Advantage note below.
Univera Healthcare. Bring your current member card so we can check your specific plan.
Aetna. Bring your member card so we can check your specific plan and benefits.
UnitedHealthcare. Bring your member card so we can check your specific plan and benefits.
Medicaid managed care. Most plans are accepted, including Independent Health (MediSource), Highmark Blue Cross Blue Shield, Molina Healthcare, Fidelis Care and UnitedHealthcare. Straight Medicaid is not; see how to check your card.
Molina Healthcare. Molina’s Medicaid managed care plans are accepted too. Bring your member card so we can check your plan.
Fidelis Care. Fidelis Medicaid managed care plans are accepted too. Bring your member card so we can check your plan.
The Empire Plan. New York State’s health insurance plan for many public employees and retirees.
TRICARE. Ask TRICARE whether your plan needs a referral or authorization for physical therapy.
Medicare. You can start without a referral. Read how Medicare physical therapy coverage works.
Workers’ Compensation. For injuries on the job. A referral is required; see Workers’ Compensation physical therapy.
No-Fault. For injuries from a car accident. A referral is required; see No-Fault coverage after a car accident.

We are not providers for Railroad Medicare, the Medicare coverage handled through the Railroad Retirement Board.

The Essential Plan rule

New York’s Essential Plan covers outpatient physical therapy only after a hospital stay or surgery for the illness or injury being treated. The therapy also has to be ordered by a physician, and the plan covers up to 60 rehabilitation visits per condition per plan year, with physical, occupational and speech therapy counted together.

So if your back started hurting on its own and you have the Essential Plan, the plan generally will not pay for physical therapy. Independent Health and Highmark, among others, offer Essential Plan coverage, so check the plan name on your member card. Our self-pay rates are one option if the Essential Plan rule applies to you.

Medicare Advantage and prior authorization

Medicare Advantage plans are run by private insurers, and they can require approval before therapy starts. Independent Health is one local example: for services on or after October 15, 2025, its Medicare plans require prior authorization through a company called Evolent before physical therapy. Bring your plan card to your first visit so the authorization request can go in before treatment.

If we are out of network for your plan

We are out of network for most Cigna and Humana plans. What that means for you depends on your plan type:

HMO plans generally do not cover out-of-network care except in an emergency.
PPO plans let you see providers outside the network for an additional cost, often through higher coinsurance.

Call your insurer, ask about your out-of-network physical therapy benefits and any deductible that applies, and compare the answer with paying on your own.

Medicaid or Medicaid managed care? Check your card

Many people in Western New York tell us they have Medicaid when their coverage is actually a Medicaid managed care plan run by a health insurer. That difference decides whether we can bill your plan:

Medicaid managed care: accepted for most plans, including Independent Health (MediSource), Highmark Blue Cross Blue Shield, Molina Healthcare, Fidelis Care and UnitedHealthcare. Independent Health calls its Medicaid managed care plan MediSource.
Straight Medicaid, also called fee-for-service Medicaid: not accepted.

New York State describes the two types this way. With Medicaid managed care, you enroll in a health plan that arranges your care and pays providers, and the plan gives you a card with its name, its logo and your Client Identification Number (CIN). With fee-for-service Medicaid, Medicaid pays providers directly, and your CIN is on your Common Benefit Identification Card (CBIC) or EBT card instead.

So check what is in your wallet:

A card from a health plan for your Medicaid coverage, such as Independent Health, Highmark, Molina, Fidelis or UnitedHealthcare. You have Medicaid managed care, and we accept most of these plans. Bring that card to your first visit.
Only the New York State CBIC. That is straight Medicaid, which we do not accept. Our self-pay rates are an option.
A Medicaid card from a plan not named here. Call us with the card and we will check, since we accept most Medicaid managed care plans.

Not sure which you have? The New York Medicaid Helpline at 1-800-541-2831 can tell you, or call us at (716) 332-4838 with your cards in hand.

Are physical therapists covered by insurance on your plan? Five questions to ask

Call the member services number on your card and ask:

Is Lake Erie Physical Therapy in network for my plan?
Do I need a referral or prior authorization for outpatient physical therapy?
How many physical therapy visits does my plan cover each year, and have any been used this plan year?
What is my copay or coinsurance for a physical therapy visit?
How much of my deductible is left?

Write down the answers, the date and the name of the person you spoke with.

What you pay at each visit

Copays and deductibles are due at each visit. If you have a secondary insurance plan, bring that card too.

With most plans, you can book without a referral under New York’s direct access rule, though some plans still require one to pay. Questions about your coverage? Call (716) 332-4838 with your insurance card in hand, or request an appointment online.

Sources

Questions

Common questions

Not sure about a referral, your coverage or your first visit? Call us and we will walk you through it.

Call (716) 332-4838

Does insurance cover physical therapy?

Many health plans cover outpatient physical therapy, but each plan sets its own rules for referrals, prior authorization, visit limits and cost-sharing. The plans we accept are listed on this page. Call your insurer, or call us at (716) 332-4838 with your card, to confirm your benefits before your first visit.

How many PT sessions will insurance cover?

It depends on your plan. Many plans set a yearly visit limit, and visits you already used this plan year, even at another clinic, may count toward it. Ask your insurer how many physical therapy visits you have left before you start.

Do you accept Medicaid?

We accept most Medicaid managed care plans, including Independent Health (MediSource), Highmark Blue Cross Blue Shield, Molina Healthcare, Fidelis Care and UnitedHealthcare. We do not accept straight, fee-for-service Medicaid, the kind billed with only New York State's Common Benefit Identification Card. Many people with a Medicaid managed care plan think they have straight Medicaid, so check your card or call us with it.

How do I know if I have Medicaid managed care?

Look at your cards. New York State explains that if you have a card from a health plan, with the plan's name and logo on it, you may already have Medicaid managed care. If your only card is the Common Benefit Identification Card (CBIC), you might have fee-for-service Medicaid. The New York Medicaid Helpline at 1-800-541-2831 can confirm which you have.

What if my plan says you are out of network?

We are out of network for most Cigna and Humana plans. HMO plans generally do not cover out-of-network care except in an emergency, while PPO plans let you see out-of-network providers for an additional cost. Ask your insurer about your out-of-network physical therapy benefits and deductible, or ask us about self-pay rates.

Does the Essential Plan cover physical therapy?

Only in limited cases. The Essential Plan covers outpatient physical therapy after a hospital stay or surgery for the condition being treated, when a physician orders it, for up to 60 visits per condition per plan year. If you are not sure which plan you have, check your member card or call your plan.

Insurance Plans We Accept