Short answer: Most major commercial plans cover pulmonary rehabilitation when it is medically necessary and ordered by your physician. Medicare Part B covers it for moderate to very severe COPD and for several other conditions. What varies is whether a specific provider bills your plan or asks you to pay cash, and whether telehealth delivery is covered the same way as an in-person clinic.
The three questions that decide your cost
People usually ask “is it covered.” The more useful question is three separate ones, because a yes to the first two can still leave you paying out of pocket.
1. Does my plan cover pulmonary rehabilitation at all?
Nearly every major commercial carrier does, as a medical benefit rather than a wellness perk. Coverage normally requires a qualifying diagnosis and a physician’s order. That order matters. Without it, the claim is likely to be denied no matter how appropriate the care is.
2. Does my plan cover it delivered virtually?
This is where plans differ most, and where the answer has shifted considerably in recent years. Ask your insurer specifically about telehealth-delivered pulmonary rehabilitation, not pulmonary rehabilitation in general. Use those words. A representative answering about clinic-based rehab may give you a different answer than the one that applies to your situation.
3. Does this provider bill my plan, or do they charge cash?
This one catches people out. A provider can be entirely legitimate, be covered by Medicare, and still ask you to pay cash because they do not contract with your commercial insurer. You will only find out by asking directly: “Will you bill my plan, or am I paying you out of pocket?”
What Bloom Medical bills
Bloom Medical bills Aetna, Cigna, Anthem BCBS, Horizon BCBS and UnitedHealthcare directly for virtual pulmonary rehabilitation. Medicare Part B is accepted in New Jersey and California, where sessions are delivered in small groups rather than one-on-one.
If your plan is not on that list, say so when you call. We will tell you plainly whether we can bill it rather than enrolling you and sorting it out later.
What to have in front of you when you call
- Your insurance card, front and back.
- Your diagnosis as your doctor wrote it, not your description of it.
- The name and phone number of the physician who manages your lung condition.
- Whether you have had a recent hospitalization or ER visit for breathing.
Frequently asked questions
Usually yes, and the amount depends entirely on your plan’s terms for outpatient therapy services. Your deductible status matters too. Ask your insurer for the copay that applies to outpatient pulmonary rehabilitation.
Many plans require it. This is normally handled between the provider and your insurer before your first session.
Medicare Advantage plans are administered by private insurers and their rules differ from traditional Medicare Part B. Ask your plan directly, and ask whether virtual delivery is included.
Check whether you qualify
Call (866) 972-8228 or fill in the eligibility form.
General information, not medical advice or a guarantee of coverage. Confirm benefits with your own insurer.
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