Insurance and referrals
Does HMSA cover pelvic floor physical therapy?
Yes. HMSA plans cover physical therapy, including pelvic floor physical therapy, when it is medically necessary. EMS Therapy is in-network with HMSA PPO and HMO plans and sees patients anywhere in Hawaii by video; some HMO plans require a referral from the primary care provider, which is checked before the first visit.
The details
What to know
Answered by the practice of Dr. Elana Shalem, DPT, pelvic floor and orthopedic physical therapist.
HMSA PPO members can usually book directly and pay their plan's physical therapy copay. HMO members typically need a referral from their PCP, and the plan may limit visits per year; both are confirmed during benefit verification so there are no surprises.
Telehealth physical therapy is covered by HMSA when the provider is licensed in Hawaii and in-network, which makes video visits a practical option on the neighbor islands, where pelvic floor specialists are scarce.
EMS Therapy verifies HMSA benefits before every new patient's first visit. Phone 808-330-7934.
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 HMSA copay for pelvic floor therapy?
The plan's physical therapy copay or coinsurance, which depends on the HMSA plan; EMS Therapy verifies it with HMSA before the first visit so there are no surprises.
Do I need a referral with HMSA?
HMSA PPO members can book directly. HMSA HMO members usually need a referral from their primary care provider; the most useful wording is "pelvic floor physical therapy, evaluate and treat," and it can be faxed to 844-886-0285.
Does HMSA cover pelvic floor therapy by video?
Yes. HMSA covers telehealth physical therapy when the provider is in-network and licensed in Hawaii. That is often the only practical access on Maui, Kauai, Molokai, Lanai and Hawaii Island, where pelvic floor specialists are scarce.
How many visits does HMSA cover?
Many HMSA plans set a yearly physical therapy visit limit; it is confirmed during benefit verification, and most pelvic floor plans of care finish within it.
Does HMSA cover pelvic floor therapy after pregnancy?
Yes. Postpartum leaking, prolapse symptoms, diastasis recti, C-section recovery and pain with intimacy are covered diagnoses when physical therapy is medically necessary.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Hawaii.
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.