Out-of-network reimbursement
Will my insurance pay me back for Physical Therapy?
The usual assumption is that if a practice does not take insurance, nothing comes back. Sometimes that is right. Often it is not, and the difference between the two is a single phone call you have not made yet.
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The good news? You can find out exactly where you stand before you spend anything. This page tells you how.
before you book
Ask Your Plan. Book With Confidence. Claim Every Month.
1. Call Your Plan.
Ten minutes, before you book.
Use the thirteen questions on our worksheet so you know your out-of-network deductible, what percentage your plan pays back, and which claim form they need from you.
2. Book and Pay
Payment is due at the visit.
Nothing changes about how you book. We do not bill your insurance and we do not contact your plan, so there is no authorization to wait on and no visit limit to work around.
3. Get Your Superbill
Automatically every month.
At the end of each month we send one superbill covering every visit in that month, with the diagnosis and procedure codes your plan needs. You never have to ask.
4. Submit The Claim
Any payment comes to you.
Send the superbill to your plan with their claim form and keep a copy. If you have out-of-network benefits and have met your deductible, they reimburse you directly.
What if the claim is denied?
A denial is not the end of it, and the deadlines are longer than most people assume.
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Start by reading why. The notice has to give a reason, and many out-of-network denials come from something fixable at our end — a missing referral, the wrong place-of-service code, no plan of care on file. Send it to us and we will correct the superbill and reissue it at no charge.
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If the reason is not a paperwork problem, you have at least 180 days to file an internal appeal with your plan, and for care you have already received the plan normally has 30 days to answer. If they refuse on medical grounds and you have exhausted that appeal, Virginia's Bureau of Insurance can refer the case to an independent reviewer whose decision binds the plan — within 120 days of the final denial.
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One honest limit: that outside review is for refusals based on medical judgment. Where a plan simply has no out-of-network benefit, there is no clinical question to review, and the appeal route generally does not help. That is what question one on the worksheet is for.
Free Downloads
Three files, free, and none of them asks for your email address.
What a superbill is, the four steps, what to do with a denial, and the thirteen questions to ask while you're on the phone with your plan.
What we would write for your HSA or FSA administrator, so you can check their requirements against it before you ask.
The form you'll receive before care begins, and your rights under it.
