Insurance & Coverage | Physical Therapy Wayne NJ | Spectrum Therapeutics

Insurance Plans We Accept

Spectrum Therapeutics of NJ is in-network with most major insurance carriers. Bring your insurance card to your first visit and we will verify your benefits before treatment begins — no surprise bills.

Carrier	Plans we accept	Referral needed to start?	What you typically pay
Aetna	All Aetna PPO and HMO plans, and Meritain Health (including POS II) — the Aetna subsidiary that administers many self-funded employer plans	No	Your specialist copay, typically $20 to $50
Horizon Blue Cross Blue Shield of NJ	Direct Access PPO, HMO, POS, PPO, OMNIA Tier 1 EPO and OMNIA HMO	No	Your specialist copay, typically $20 to $50
Blue Cross Blue Shield (other states)	BlueCard PPO and BCBS reciprocity, including CareFirst BCBS	No	Your specialist copay, typically $20 to $50
Anthem BCBS	All Anthem Blue Cross Blue Shield plans	No	Your specialist copay, typically $20 to $50
Empire BCBS	All Empire plans, including the Empire Plan (NY and NJ public employees)	No	Your specialist copay, typically $20 to $50
Cigna	Commercial PPO, HMO and Open Access Plus (OAP) plans	No	Your specialist copay, typically $20 to $50
UnitedHealthcare	Choice, Choice Plus and Options PPO	No	Your specialist copay, typically $20 to $50
Oxford Health Plans	All Oxford plans	No	Your specialist copay, typically $20 to $50
Oscar Health	All Oscar individual and group plans	No	Your specialist copay, typically $20 to $50
Humana	Commercial plans	No	Your specialist copay, typically $20 to $50
Qualcare	All Qualcare plans	No	Your specialist copay, typically $20 to $50
CareConnect	ACA marketplace EPO	No	Your specialist copay, typically $20 to $50
⚠️ Original Medicare (Part B)	Traditional Medicare Part B	Yes — a physician’s script is required. We obtain it from your doctor, so it does not hold up your first appointment	Your plan’s standard Part B cost-sharing; a supplement often covers the balance
⚠️ Medicare supplement / Medigap	All supplement plans, including AARP-branded	Yes — same as Original Medicare. We obtain the script for you	Usually little or nothing after the supplement pays
⚠️ Medicare Advantage	AARP (PPO, HMO, POS, Indemnity), Clover Health and Braven Health	Yes — every Medicare Advantage plan requires a script. We obtain it for you	Your plan’s copay
Workers’ compensation	All NJ workers’ comp carriers — we handle the authorization	No	100% covered. Zero out-of-pocket.
Auto / PIP / no-fault	All NJ auto insurance, under your PIP coverage	⚠️ Yes — physical therapy is not reimbursable under PIP without a referral	Covered under PIP

Plan names change and employers switch administrators, so we verify your specific benefits before treatment begins either way — bring your card to the first visit and there are no surprise bills.

Medicare: you still do not need to chase anything

Every Medicare plan — Original Medicare, a Medigap supplement including the AARP-branded ones, and every Medicare Advantage plan — requires a physician to certify the plan of care. That is a Medicare rule about what gets paid, and it is separate from New Jersey’s direct access law, which governs whether you may be seen. You do not need the script in hand to book. Call, get on the schedule, and the office obtains it from your physician.

Braven Health is not Horizon NJ Health

Both carry Horizon branding and they are easy to confuse. Braven Health is a Medicare Advantage plan and we accept it. Horizon NJ Health is Horizon’s Medicaid plan and we cannot. If your card says Horizon and you are unsure which one you hold, call and we will check it for you in a couple of minutes.

Don't see your plan? Call (973) 689-7123 — we work with most carriers and can usually verify coverage in under 5 minutes. Out-of-network superbills are also available for reimbursement through your carrier.

Plans We Cannot Accept

We are not able to accept the following plans at this time:

• Medicaid / NJ FamilyCare
• Aetna Better Health
• Fidelis / WellCare
• UnitedHealthcare Community Plan
• Horizon NJ Health
• AmeriHealth
• Cigna-HealthSpring (Cigna’s Medicare Advantage product — separate from Cigna commercial, which we do accept)

Horizon NJ Health is not the same as Horizon Blue Cross Blue Shield of New Jersey. Horizon NJ Health is Horizon's Medicaid plan; Horizon BCBS NJ is the commercial plan, and we do accept it. If you are not sure which one you have, call (973) 689-7123 and we will check for you. Self-pay rates and out-of-network superbills are available either way.

How to Verify Your Coverage in 5 Minutes

1. Call us at (973) 689-7123 with your insurance card in hand
2. We verify your physical therapy benefits, copay, deductible status, and any visit limits in real time
3. We confirm whether your plan requires a doctor referral (most do not for the first 30 days under NJ direct-access law)
4. You walk in for your first visit knowing exactly what you owe — no surprises

No Doctor Referral Needed in New Jersey

Under New Jersey's direct-access law, you can begin physical therapy without a physician referral for the first 30 days of care. After 30 days, most plans require a referral to continue. We help you obtain one quickly through your primary care doctor or one of our partner physicians.

Medicare is the exception. On every Medicare plan — Original Medicare, a Medigap supplement, or a Medicare Advantage plan — you will need a prescription for physical therapy from your doctor, because Medicare requires a physician to certify your plan of care. It does not delay your booking; call us and we will tell you exactly what your doctor needs to send.

This saves most patients 2 to 3 weeks compared to waiting for a referral first.

Workers' Compensation and Auto / PIP Patients

If your injury was work-related (workers' comp) or from a motor vehicle accident (auto / PIP / no-fault), your treatment is covered with $0 out-of-pocket cost to you. We handle all the authorization paperwork and billing directly with the insurance carrier or attorney.

• Workers' Comp: Bring your case number and the name of your adjuster — we handle the rest
• Auto / PIP: Bring your auto insurance information and the police report (if applicable)
• Attorney-represented cases: We coordinate directly with your attorney's office

Out-of-Network and Self-Pay Options

If your plan is not in-network with us — or if you prefer self-pay for privacy reasons — we offer:

• Transparent self-pay rates — published, no surprises
• Out-of-network superbills — you pay us at the visit and submit to your insurance for reimbursement (most PPO plans reimburse 50–80% after deductible)
• HSA / FSA accepted — physical therapy is a qualified medical expense

Further Reading: Insurance & Coverage Patient Resources

Patient guides from our blog on related topics:

• The Insurance Maze That's Keeping You in Pain (And What I Do About It)
• Direct Access Physical Therapy in New Jersey: No Referral Needed
• Insurance Plans Accepted at Spectrum Therapeutics Wayne NJ

Frequently Asked Questions About Insurance Coverage

Does Aetna cover physical therapy in Wayne, NJ?

Yes. Spectrum Therapeutics of NJ is in-network with Aetna for all PPO and HMO plans. Most Aetna patients have a $0–$50 copay per visit depending on plan. Call us with your member ID and we will verify your specific benefits in 5 minutes.

Does Horizon Blue Cross Blue Shield cover physical therapy?

Yes. We are in-network with all Horizon BCBS NJ plans, including Horizon Direct Access and OMNIA. Most patients pay between $0 and $40 per visit. We handle all authorization paperwork.

Does Cigna cover physical therapy in Wayne?

Yes. Cigna PPO, HMO, and OAP plans are accepted. Visit caps and copays vary by plan — we verify your specific benefits before your first visit.

Does Medicare cover physical therapy?

Yes. We accept Original Medicare (Part B), Medigap supplements including the AARP-branded plans, and the Medicare Advantage plans from AARP, Clover Health and Braven Health. On every Medicare plan a physician's script is required, because Medicare requires a doctor to certify your plan of care — but you do not need it in hand to book. Call and get on the schedule; our office obtains the script from your physician. Medicare typically covers 80% of approved physical therapy charges after your deductible — we bill Medicare directly.

Does UnitedHealthcare cover physical therapy?

Yes. We are in-network with all UnitedHealthcare plans including Choice, Choice Plus, Options PPO, and Oxford. Most patients have low or no copay.

Do I need a doctor's referral to start physical therapy in NJ?

Not on a commercial plan — for the first 30 days New Jersey is a direct-access state and you can begin PT with us without a physician referral. On Medicare the answer is yes: every Medicare plan requires a prescription for physical therapy from your doctor, because Medicare requires a physician to certify your plan of care. Some commercial plans also require a referral for coverage; we verify that when we check your benefits.

What if my plan is not on your list?

Call us at (973) 689-7123. We accept most major carriers and can verify coverage even if your specific plan is not listed. If we are not in-network, we offer transparent self-pay rates and out-of-network superbills for reimbursement.

Do you accept Medicaid, NJ FamilyCare, or Horizon NJ Health?

No. We are not able to accept Medicaid / NJ FamilyCare, Horizon NJ Health, Aetna Better Health, Fidelis / WellCare, or UnitedHealthcare Community Plan. Horizon NJ Health is Horizon's Medicaid plan and is not the same as Horizon Blue Cross Blue Shield of New Jersey, which we do accept. If you are not sure which one you have, call (973) 689-7123 and we will check for you. Self-pay rates and out-of-network superbills are available either way.

Are workers' comp and auto accident PT covered?

Yes — with $0 out-of-pocket cost to you. We handle all authorization paperwork and bill the workers' comp carrier or auto / PIP insurance directly.

Can I use my HSA or FSA to pay?

Yes. Physical therapy is a qualified medical expense for both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

↑ Part of Physical Therapy Guides

Do I need a doctor referral to start physical therapy in NJ?

Not on a commercial plan - for the first 30 days New Jersey is a direct-access state and you can begin PT without a physician referral. On Medicare the answer is yes: every Medicare plan requires a prescription for physical therapy from your doctor, because Medicare requires a physician to certify your plan of care. Some commercial plans also require a referral for coverage.

Are workers compensation and auto accident PT covered?

Yes, with no out-of-pocket cost to you. We handle all authorization paperwork and bill the workers comp carrier or auto/PIP insurance directly.

Can I use my HSA or FSA to pay for physical therapy?

Yes. Physical therapy is a qualified medical expense for both Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).