Whether online pulmonary rehab is covered depends on your plan, not on one universal rule. Commercial plans write their own policies, and those policies can differ on referrals, prior authorization and whether rehab delivered by video counts. This guide explains what to ask and in what order, so you can find out before your first session instead of after the bill arrives.
Is online pulmonary rehab covered by commercial insurance?
It can be, but the answer sits in your own plan documents. Rehab delivered by live video is billed differently from rehab in a clinic, and not every plan treats the two the same way. One regional Blue Cross Blue Shield plan publishes a medical policy for outpatient pulmonary rehabilitation that does not address telehealth or virtual delivery, and says home-based pulmonary rehabilitation programs are not covered for all of its products. (Blue Cross and Blue Shield of Rhode Island, Outpatient Pulmonary Rehabilitation policy) That is one plan, and it is a reminder to ask about your plan specifically rather than assume.
Our broader guide, does insurance cover pulmonary rehab, covers the basics of coverage. This page focuses on the extra questions that come up when rehab is online.
Does online rehab work as well as rehab in a clinic?
Insurers often ask this, and it is fair to ask. A Cochrane review of telerehabilitation for people with COPD concluded that it achieves outcomes similar to traditional centre-based pulmonary rehabilitation, and found no safety problems. The same review said the certainty of the evidence was generally low, and that its studies were few and varied, with 99% of participants having COPD, so results may not apply to every lung condition or every technology. (Cochrane, Telerehabilitation for people with COPD) For more on this question, see is virtual pulmonary rehab as effective as in person.
Do I need a referral or a doctor’s order?
MedlinePlus says your health care provider may recommend pulmonary rehabilitation if you have a chronic lung disease. (MedlinePlus, Pulmonary Rehabilitation) Whether your plan needs a formal referral or a written order is a plan rule, so ask your insurer. Even when a plan does not require one, a note from your doctor that names your diagnosis makes it easier to confirm benefits. Our page on whether you need a referral for pulmonary rehab walks through the usual steps.
What is prior authorization, and will online rehab need it?
HealthCare.gov defines preauthorization, also called prior authorization, as a decision by your health insurer or plan that a service is medically necessary. It says your plan may require preauthorization for certain services before you receive them, and that preauthorization is not a promise your plan will cover the cost. (HealthCare.gov, Preauthorization) Plans differ here too. The Blue Cross Blue Shield policy mentioned above lists prior authorization as not applicable, while another plan may require it. Ask your plan, and ask whether the answer is the same for rehab delivered by video.
What should I ask my insurance company?
Call the member services number on your card and write down the date, the name of the person you speak with and what they tell you. These questions cover most of the ground:
- Does my plan cover pulmonary rehabilitation for my diagnosis?
- Is rehab delivered by live video covered, or only rehab in a clinic?
- Do I need a referral or a written order from my doctor?
- Does the program need prior authorization, and who requests it?
- What are my copay or coinsurance, and how much of my deductible is met?
- Is there a limit on the number of sessions or visits per year?
- Is the provider in network, or will I be billed as out of network?
Ask the provider to check too. Bloom Medical Group bills commercial insurance, and our team can check whether we can bill your plan before you start. You can also use our guide to how to choose a virtual pulmonary rehab program to compare programs on more than price.
Prepare your notes before you call
A short set of notes keeps the call and the doctor visit on track. The American Lung Association suggests tracking your daily COPD symptoms, sleep patterns and how you feel on good days and bad days. (American Lung Association, COPD Action Plan and Management Tools) The National Heart, Lung, and Blood Institute guide for visiting the doctor suggests tracking symptoms each day and bringing them to every appointment, keeping a list of all medicines, and preparing questions ahead of time. (NHLBI, COPD Caregiver’s Toolkit: Visiting the Doctor) We turned these ideas into a short video that goes with this article.
What about Medicare?
Medicare has its own coverage rules for pulmonary rehab, which we explain in does Medicare cover pulmonary rehab. Bloom is not able to accept Medicare at this time.
How does Bloom run rehab?
Every rehab session at Bloom Medical Group is one on one, each patient gets an individualized treatment plan, and we meet every patient where they are. Sessions are live by video from home, run by licensed respiratory therapists and clinical exercise physiologists, and billed to commercial insurance. Education sessions about your condition may include other patients.
Frequently asked questions
It depends on your plan. Commercial plans write their own policies, and they can differ on whether rehab delivered by video is covered, whether you need a referral and whether prior authorization is required. Call the number on your insurance card and ask about your plan specifically.
Whether you need a referral or written order is a rule of your plan, so ask your insurer. MedlinePlus says your health care provider may recommend pulmonary rehabilitation if you have a chronic lung disease, and a note from your doctor naming your diagnosis can help when benefits are checked.
HealthCare.gov defines preauthorization, also called prior authorization, as a decision by your insurer or plan that a service is medically necessary. Your plan may require it before you receive a service, and it is not a promise that the plan will cover the cost.
A Cochrane review found that telerehabilitation for people with COPD achieves outcomes similar to centre-based pulmonary rehabilitation, with no safety problems found. The authors rated the certainty of the evidence as generally low, so talk with your doctor about whether it fits you.
Ask whether your plan covers pulmonary rehab for your diagnosis, whether video sessions are covered, whether you need a referral or prior authorization, what your copay and deductible are, whether there is a session limit, and whether the provider is in network.
Bloom bills commercial insurance, and our team can check whether we can bill your plan before you start. Every rehab session is one on one and live by video, run by licensed respiratory therapists and clinical exercise physiologists. Bloom is not able to accept Medicare at this time.
Next step
Not sure whether rehab fits you? Take our free 2 minute lung health assessment.
Ready to talk? Call 1-866-972-8228 or fill out the see if you qualify form.
This article is for education only and is not medical advice. Talk with your doctor about what is right for you.
Sources
- Cochrane, Telerehabilitation for people with COPD
- HealthCare.gov, Preauthorization
- Blue Cross and Blue Shield of Rhode Island, Outpatient Pulmonary Rehabilitation policy
- MedlinePlus, Pulmonary Rehabilitation
- American Lung Association, COPD Action Plan and Management Tools
- NHLBI, COPD Caregiver’s Toolkit: Visiting the Doctor
