Determine Your Benefits
How to Determine Your Benefits for Physical Therapy
Information You’ll Need to Get from Your Insurance Provider
- What is your out of network deductible and how much has already been met?
- What is your percentage of reimbursement? This means what is the percentage that the insurance provider will pay on your claim.
- Does the insurance require any special claim form to fill out? This is usually on the insurance’s website.
- What is the mailing address you should submit the claims to?
- Does the insurance need a copy of the doctor’s referral and/or a copy of the physical therapy evaluation?
- Does the insurance require a copy of the therapy notes for each claim?
What this Information Means
- An out of network deductible must be satisfied before the insurance company will pay for the claim.
- If you have met the out of network deductible you may have a co-pay or co-insurance (which is usually a % of the total bill) that will be deducted from the claim amount. This is considered to be your responsibility whether or not you are in or out of network.
- Your insurance company may have an established “reasonable and customary price” for the service codes rendered. This price will not necessarily match the charged billed; some may be less and some may be more.
- After you file your claim the insurance provider should provide you with an EOB (explanation of benefits).
This checklist was created to assist you in obtaining reimbursement for Physical Therapy services but is not a guarantee of reimbursement to you.
Please contact our business office if you have any further questions or need help in understanding this process at 972 722-1212.
“Physical therapy is one of the best choices you can make when you have chronic pain. It makes you stronger and helps you move and feel better.”
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We help people who suffer from pain become more active without the need for pain medication using natural treatment techniques.
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203 N. Alamo Rd. Rockwall, TX 75087