Rehabilitation benefits and coverage*

FCHP covers outpatient rehabilitation services as shown below. You may pay copayments for the services shown; you also may be responsible for a deductible for certain services.

What's covered?

Service or procedure
Physical and occupational therapy services are covered for up to 60 visits combined per calendar year when medically necessary.
Medically necessary services for the diagnosis and treatment of speech, hearing and language disorders when services are provided by a speech-language pathologist or audiologist
Cardiac rehabilitation services to treat cardiovascular disease in accordance with state law and department of Public Health regulations
Medically necessary early intervention services delivered by a certified early intervention specialist, according to operational standards developed by the department of Public Health,for children from birth to their third birthday


What isn't covered?

Service or procedure
Long-term rehabilitation services
Maintenance treatment or services
Services for non-acute chronic conditions. Chronic conditions are those that exist for an extended time or continue past the expected recovery time for acute or short-term conditions. For example, FCHP defines chronic pain as continuing for more than three months after the injury or illness causing the original pain.
Services that are not determined to be medically necessary. This applies to physical therapy, speech therapy, occupational therapy and chiropractic care, even if the plan limits have not yet been reached.
Acupuncture
Aquatic therapy or massage therapy, including myotherapy (when not provided by a FCHP provider or physical therapist as part of your covered physical therapy benefit).
Early intervention services for patients over age 3

Referral and authorization**

For rehabilitation services, your PCP needs to give you a referral to see a specialist. For some services, your PCP must also get authorization from FCHP before giving you the referral. An authorization is an assurance by FCHP to pay for medically necessary covered services provided by a network provider. If you receive services from any doctor, hospital or other health care provider without getting a referral from your PCP (or authorization, if needed), you will have to pay for these services yourself.

For details on your specific benefits, coverage, and copayments:

  • Refer to your Member Handbook, Benefit Summary or Schedule of Benefits
    or
  • Call our customer service department at:
    1-800-868-5200 (TDD/TTY: 877-608-7677), Monday through Friday, 8 a.m. to 6 p.m.

* Benefits and coverage may vary by product, plan design and employer.  For specific details regarding your FCHP plan, benefits and features, please check with your employer or contact a member of our customer service team at 1-800-868-5200 (TDD/TTY: 1-877-608-7677), Monday through Friday, 8 a.m. to 6 p.m. Eastern time.  MassHealth members can call the MassHealth Customer Service Center at: 1-800-841-2900 (TDD/TTY: 1-800-497-4648) Monday through Friday, 8 a.m. to 5 p.m.

** PPO plan members do not need referrals for rehabilitation services.