Physiotherapy and therapy session caps in private policies

Key rules

• Session cap: Therapy is usually limited to a set number of sessions per year or per process, and the number depends on your insurer and product.
• Prescription: You usually need a doctor's prescription before physiotherapy or speech therapy, and psychology may need a referral.
• Authorisation: Get the insurer's approval before your first session, or you may be billed for the treatment.
• Copayment: Some policies charge a fee per session even within the cap.

Session limits and approval rules vary by insurer and product, so confirm the current figures and steps in your policy's cover table or with the insurer.

Expect a cap on sessions

Many private policies limit physiotherapy, psychology (or psychotherapy), speech therapy and similar treatments. The limit is usually a number of sessions per year or per treatment process. Some premium products remove certain limits.

The exact number depends on the insurer and the product tier, so read the cover table in your policy. Don't assume the figure from a friend's policy applies to yours.

Which therapies get the lowest caps

Psychology and speech therapy often have a lower cap than physiotherapy. Some policies also charge a copayment on each session, even inside the cap. Look for both the session number and any per-session charge before you buy or start treatment.

You need a prescription first

For physiotherapy, speech therapy and similar treatments, the policy typically asks for a prescription from a doctor. This is often a specialist in the insurer's network.

Psychology often needs a referral from a doctor or psychiatrist. Some insurers allow direct access for a small number of sessions. Ask which applies to you.

Then the insurer must approve

Many policies also require prior authorisation from the insurer. The provider often requests it for you, or you can use the insurer's app or phone line. You will usually need to give the diagnosis and the number of sessions.

Get approval before the first session. If you treat without authorisation, the insurer may not cover it, and the provider may bill you.

Network and reimbursement policies differ

These steps describe policies where you use the insurer's list of doctors (the cuadro médico). If your policy reimburses costs instead, the rules for approval and repayment can differ, so ask the insurer how it works.

The checklist and the questions below walk you through the steps.

Checklist

• Find the physiotherapy, psychology and speech therapy lines in your policy's cover table and note the sessions allowed per year or per process.

• Check whether any session carries a copayment, and note the amount.

• Ask your doctor, often a network specialist, for a prescription before you start any therapy.

• Ask the insurer whether prior authorisation is needed, and request it through the provider, the insurer's app or its phone line.

• Give the diagnosis and the number of sessions when you request authorisation.

• Ask whether psychology needs a doctor's referral or allows direct access for a few sessions.

• Confirm approval before the first session, so the treatment is not billed to you.

Frequently asked questions

Can I see a psychologist without a doctor's referral?

It depends on the insurer, but some let you see a psychologist directly for a limited number of sessions. Others ask for a referral from a doctor or psychiatrist first. Ask your insurer before booking, because sessions without the right approval may not be covered.

What happens if I start physiotherapy without authorisation?

You may have to pay for the treatment yourself, because unauthorised sessions may not be reimbursed or may be billed to you. Ask the provider or your insurer's app or phone line to get approval first. The request usually states the diagnosis and the number of sessions.

Is the session limit the same for physiotherapy and psychology?

No, psychology and speech therapy often have a lower cap than physiotherapy. Limits are set per year or per process, and some policies add a copayment per session.