Does VHIS cover physical therapy? 4 key tips before claiming
Is Physiotherapy Covered by VHIS?
Regarding whether VHIS covers physiotherapy medical expenses, the answer depends on the nature of the physiotherapy, and not all situations are covered.
Regardless of whether it’s the Bowtie VHIS Standard Plan or the Bowtie VHIS Flexi Regular Plan policy, the following situations for physiotherapy-related expenses are still covered:
- Physiotherapy received during hospitalization
- Physiotherapy received before/after admission or before/after day surgery, and related to hospitalization or surgery
When Is Physiotherapy Not Covered by VHIS?
VHIS is a medical insurance focused on inpatient coverage, so if your injury does not require hospitalization or surgery, for example, due to muscle strains or minor sprains , and you receive physiotherapy at a medical institution, the related treatment expenses are not covered under VHIS.
Can You Claim for Physiotherapy? Check Out Two Examples
Example 1: Spraining an ankle while hiking and receiving treatment at a physiotherapy center
Alfred loves hiking with friends on weekends. One day, while crossing a stream with his group, he accidentally twisted his ankle and sprained it. With his friends’ help, he made it down the mountain and went to a recommended physiotherapy center for treatment. The physiotherapist applied ice and bandaged the injured area, diagnosing it as a moderate ligament strain and recommending follow-up visits over the next 6 weeks. After several weeks of treatment, Alfred’s condition gradually improved.
Alfred holds a Bowtie VHIS Flexi Regular Plan policy and applied to the insurance company for reimbursement of several thousand dollars in physiotherapy expenses over the weeks, but his claim was denied.
Reimbursement Situation:
- Physiotherapy expenses: ❌ Not covered
- Reason: The insurance company stated that Alfred’s sprain did not involve hospitalization or day surgery, so according to the VHIS policy terms, they would not reimburse the outpatient physiotherapy expenses.
Example 2: Fracturing a bone while trail running, requiring hospitalization, surgery, and post-surgery physiotherapy
Alfred’s friend Betty is also an avid hiker and trail runner. During one training session, she twisted her ankle and fell on a bumpy section, causing immediate pain and swelling in her lower leg. Fortunately, she was not far from the road, and with her friends’ assistance, she took a taxi to the emergency department of a private hospital.
At the hospital, the doctor examined and initially treated the injured area, then arranged for her admission and an X-ray, which revealed a fracture in her lower leg bone. Surgery was recommended. After the surgery, Betty stayed in the hospital for 2 more nights for observation and needed regular physiotherapy for the next 3 months as part of her post-surgery rehabilitation.
Betty later submitted a claim for the private hospital’s outpatient, inpatient, surgery, and post-surgery physiotherapy expenses under her Bowtie VHIS Flexi Regular Plan policy.
Compensation Situations:
- Outpatient Fees: ✅ Covered
- X-ray Examination Fees: ✅ Covered (considered as miscellaneous expenses during hospitalization)
- Hospitalization and Surgery Fees: ✅ Covered
- Post-surgery Physiotherapy Fees: ✅ Covered (for up to 3 sessions within 90 days after surgery)
Physiotherapy Claims on VHIS: 4 Key Considerations
1. Check Physiotherapist Qualifications
If you wish to claim physiotherapy fees under voluntary health insurance, you must first ensure that the physiotherapy services are provided by a registered physiotherapist, as there are various places or therapists offering treatments for muscle and bone injuries, such as traditional bone-setting, Chinese medicine massage and acupuncture, and chiropractors (not the same as registered doctors).
Unless a specific voluntary health insurance “Flexi Plan” has additional coverage, or the policy specifically states otherwise, voluntary health insurance generally does not cover treatments provided by persons other than registered doctors or registered physiotherapists.
2. Note the Claim Limit
Physiotherapy can involve one or two sessions, or it can be a longer-term treatment (such as ongoing follow-ups for 3 to 6 months), and voluntary health insurance policies generally set a limit on the number of outpatient or physiotherapy claims. Therefore, voluntary health insurance policies typically do not cover long-term ongoing physiotherapy fees.
For example, under the Bowtie VHIS Standard plan, the policy only provides coverage for the “one before and three after,” totaling 4 sessions, with a per-session claim limit of $580 and an annual claim limit of $3,000.
3. Be Aware of Exclusions
Even if the physiotherapy fees meet the requirements related to hospitalization or surgery, if the cause of injury or treatment involves exclusions under voluntary health insurance, the insurance company may still deny the claim.
Common exclusions under voluntary health insurance include treatments not medically necessary, reliance on or overuse of drugs/alcohol/illicit substances, intentional self-injury or attempted suicide, participation in illegal activities, preventive treatments/preventive care, and congenital conditions diagnosed before the insured person turns 8 years old.
4. Check Required Documents
If you want to claim compensation for physiotherapy fees, you must submit a claim form completed by a registered doctor to the insurance company, and the doctor must clearly state the diagnosis on the form. Additionally, if there are other medical reports, referral letters, or imaging diagnostic reports like X-rays, you should submit them together to avoid delays in the claim process due to insufficient documentation.
Frequently Asked Questions
Accident Insurance generally covers physiotherapy expenses resulting from accidents and is not limited to treatments before or after hospitalization or surgery. However, different insurance products have varying terms and restrictions, so it’s important to understand the policy’s coverage before purchasing to avoid claim denials later.
Unless the policy specifically states otherwise or certain voluntary health insurance flexible plans include related add-on coverage, most medical insurance and voluntary health insurance on the market do not cover chiropractic or bonesetting expenses. Some accident medical insurance products may cover treatments by registered chiropractors or registered Chinese medicine practitioners specializing in orthopedics (commonly known as bonesetters), but note that these products only cover expenses arising from accidents.
