CareSource covers physical therapy for its Indiana members, but how depends on the plan: its Healthy Indiana Plan and Hoosier Healthwise members follow Indiana Medicaid’s therapy rules, while CareSource Marketplace members follow the terms of the plan they bought. In the Medicaid plans, therapy needs an order from a qualifying provider and usually prior authorization after the first evaluation. The matching team asks which CareSource plan you have and tells you honestly whether a therapist in the network can see you under it.
Last reviewed By the Monon Therapy Collective editorial team
- Indiana plans
- HIP, Hoosier Healthwise and Marketplace
- Medicaid plans need
- An order and, after the evaluation, usually prior authorization
- Marketplace plans follow
- Your plan’s schedule of benefits
- Check first
- Member services number on your ID card
Which CareSource plans are sold in Indiana?
CareSource’s Indiana site lists three: the Healthy Indiana Plan (HIP) for qualified adults aged 19 to 64, Hoosier Healthwise for children under 19 and pregnant women, and Marketplace plans for individuals and families, sold both on and off the exchange.
The first two are Indiana Medicaid programs that CareSource manages for the state. The third is private insurance you buy, often with a premium tax credit. Your ID card names the plan, and the plan decides which set of therapy rules applies to you.
How does physical therapy work on CareSource HIP or Hoosier Healthwise?
It follows Indiana Medicaid’s therapy policy, administered by CareSource. Under the Indiana Health Coverage Programs therapy manual, physical therapy must be ordered by an enrolled provider such as a physician, nurse practitioner or physician assistant, and the initial evaluation is exempt from prior authorization while most treatment after it is not.
For HIP members, the plan level matters too: the state says HIP Plus allows more physical therapy visits than HIP Basic. The broader rules, including the two-year limit on rehabilitative therapy for adults, are set out on the page about Medicaid and the Healthy Indiana Plan.
What should a CareSource Marketplace member check about therapy?
Check the schedule of benefits for your exact plan. Marketplace plans must cover rehabilitative services as an essential health benefit, according to HealthCare.gov, but each plan sets its deductible, copay or coinsurance and any visit limit, and these differ between bronze, silver and gold tiers.
Look for three lines: the cost of an outpatient rehabilitation visit, whether that cost applies before or after the deductible, and the number of visits allowed per year. The answer on copay versus coinsurance explains how those figures turn into a bill.
Who sends the prior authorization request to CareSource?
The treating provider’s office does, not you. CareSource takes prior authorization requests from providers, and a therapy request usually includes the evaluation findings, the plan of care and the number of visits requested.
Your part is to make sure the office has your current member ID and that the ordering provider’s note is on file. If a request is denied, CareSource must send you a written notice that explains how to appeal, and the therapist’s office can tell you whether more documentation might change the outcome.
What should I ask CareSource before booking therapy near Carmel?
Call the member services number on your card with these questions, then complete the questionnaire so the matching team knows the plan and the problem. For general tips, see how to find a physical therapist who takes your insurance.
- Which CareSource plan am I on: HIP Plus, HIP Basic, Hoosier Healthwise or Marketplace?
- Does the therapist I am considering appear in the CareSource provider directory?
- Does my therapy need prior authorization, and how many visits does one approval cover?
- What is my cost per visit, and how many visits are allowed this year?
