Insurance and referrals
Does CareFirst BlueCross BlueShield cover pelvic floor physical therapy?
Yes. CareFirst BlueCross BlueShield plans cover physical therapy, including pelvic floor physical therapy, when it is medically necessary. EMS Therapy is in-network with CareFirst and sees members anywhere in Maryland by video; Maryland allows physical therapy without a referral, though some CareFirst HMO plans still require one.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
Copays and visit limits vary by CareFirst plan and are confirmed during benefit verification. Telehealth physical therapy is covered when the provider is in-network and licensed in Maryland.
For members on the Eastern Shore, in Southern Maryland, and in the western counties, where pelvic floor specialists mean a drive to Baltimore or Washington, video visits replace the trip.
EMS Therapy is also in-network with Aetna and traditional Medicare in Maryland, and verifies CareFirst benefits before the first visit. Phone 786-273-9151.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Questions
Common follow-up questions
What is the CareFirst copay for pelvic floor therapy?
It is the plan's physical therapy copay or coinsurance, which varies by plan and employer; many CareFirst PPO and BlueChoice plans have a flat specialist copay per visit after any deductible. EMS Therapy verifies the exact amount with CareFirst before the first visit.
Do I need a referral for pelvic floor therapy with CareFirst?
Usually not. Maryland allows physical therapy without a referral, and CareFirst PPO and most BlueChoice plans do not require one. Some CareFirst HMO plans still require a referral from the primary care provider; that is checked during benefit verification.
Does CareFirst cover pelvic floor therapy by telehealth?
Yes. CareFirst covers physical therapy by video when the provider is in-network and licensed in Maryland. EMS Therapy sees CareFirst members anywhere in Maryland from home, including the Eastern Shore, Southern Maryland and the western counties.
How many visits does CareFirst cover?
Most CareFirst plans cover a set number of physical therapy visits per year, commonly 30 or more; the limit is confirmed before the first visit, and most pelvic floor plans of care finish within it.
Is EMS Therapy in-network with CareFirst?
Yes, in Maryland, for both women's and men's pelvic floor physical therapy and orthopedic physical therapy. EMS Therapy is also in-network with traditional Medicare and Aetna in Maryland.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Maryland.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.