Physical Therapy vs Cortisone Injections: aetna Coverage
Side-by-side comparison of aetna coverage for physical therapy and cortisone injections, including coverage status, prior authorization requirements, and estimated costs.
Coverage Comparison
How aetna covers each treatment option side by side.
| Factor | Physical Therapy | Cortisone Injections |
|---|---|---|
| Coverage Status | Covered | Covered |
| Prior Authorization | Not Required | Not Required |
| Estimated Cost | $75-$150 per session (before insurance) | $100-$300 per injection (with insurance copay typically $20-$50) |
| Evidence Level | strong | strong |
| Requirements | None listed | None listed |
Which Is Better Covered by aetna?
Both Physical Therapy and Cortisone Injections are typically covered by aetna. Compare the specific requirements and costs below to determine which may be more cost-effective for you.
Overall Comparison Verdict
Research consistently shows physical therapy provides better long-term outcomes than cortisone injections for most joint conditions. A landmark 2020 NEJM study found PT was as effective as cortisone for shoulder pain at one year. However, cortisone has a clear role in managing acute flares. The best approach often combines both, using cortisone to manage acute pain while building strength through PT.
Best for: Physical therapy for long-term joint health and function; cortisone for acute flare-ups and short-term pain relief when you need to function immediately.
See full comparisonCoverage Details
Physical Therapy
Cortisone Injections
Cost Comparison Under aetna
Physical Therapy
Cortisone Injections
Costs are estimates and may vary by specific plan, location, and provider. Contact aetna directly to verify your benefits.
Appeal Tips
If coverage is denied for either treatment, here are tips for appealing with aetna:
- Get prescription first
- Use in-network supplier
Steps to Get Covered by aetna
Follow this process to get your treatment approved and minimize out-of-pocket costs.
Verify Your Benefits
Call aetna or log into your member portal to confirm your specific plan covers the treatment you're considering. Ask about deductibles, copays, and any limitations.
Get a Referral (If Required)
Some aetna plans require a referral from your primary care doctor to see a specialist. Check your plan type (HMO plans usually require referrals, PPO plans often don't).
Submit Prior Authorization
If prior authorization is required, your doctor's office will submit the request with clinical documentation including your diagnosis, imaging results, and records of previous treatments tried.
Wait for Approval
aetna typically processes prior authorization requests within 5-15 business days. Urgent requests may be expedited. Your doctor's office can follow up on the status.
Schedule Your Treatment
Once approved, schedule your treatment with an in-network provider to minimize out-of-pocket costs. Keep your approval reference number for your records.
Appeal If Denied
If denied, request the denial in writing and work with your doctor to submit an appeal with additional supporting documentation. Many denials are overturned on appeal.
Frequently Asked Questions
Does aetna cover Physical Therapy?
Yes, aetna typically covers Physical Therapy. Prior authorization is generally not required. The estimated out-of-pocket cost is $75-$150 per session (before insurance). Contact aetna directly to verify your specific plan benefits.
Does aetna cover Cortisone Injections?
Yes, aetna typically covers Cortisone Injections. Prior authorization is generally not required. The estimated out-of-pocket cost is $100-$300 per injection (with insurance copay typically $20-$50). Verify your specific benefits with aetna before scheduling treatment.
Which has lower out-of-pocket costs with aetna: Physical Therapy or Cortisone Injections?
With aetna, the estimated cost for Physical Therapy is $75-$150 per session (before insurance) and for Cortisone Injections is $100-$300 per injection (with insurance copay typically $20-$50). Both are typically covered, so your out-of-pocket costs depend on your specific plan details including deductible, copay, and coinsurance amounts. Always verify costs with your insurance before scheduling.
Do I need prior authorization for Physical Therapy or Cortisone Injections with aetna?
Neither Physical Therapy nor Cortisone Injections typically requires prior authorization with aetna. However, your provider should still verify eligibility before scheduling treatment.
What if aetna denies coverage for my treatment?
If aetna denies coverage, you have the right to appeal. First, ask for the denial in writing with the specific reason. Then work with your doctor to submit an appeal with supporting clinical documentation, imaging results, and records of failed conservative treatments. Many initially denied claims are approved on appeal. You can also contact your state insurance commissioner if you believe the denial is unfair.
Quick Links
Verify Your Coverage
Coverage can vary by specific plan. Contact aetna directly to verify your benefits for both physical therapy and cortisone injections.
Physical Therapy vs Cortisone Injections with Other Insurance
Interested in This Treatment?
You've learned about Physical Therapy vs Cortisone Injections coverage with aetna. Here's how to move forward:
Take Assessment
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Check Coverage
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Have questions? Contact us or call 1-800-555-0123