OUT-OF-NETWORK(OON)/NON- PREFERRED INSURANCE BENEFITS GUIDE

Navigating insurance can be difficult, we will do everything we can to help you with this process at Think Physical Therapy PLLC. Read below for some information and tips on how to get the most out of your Out-of-network/Non-preferred benefits. (again, as Think PT does not participate with any insurances/is not enrolled with any insurance companies at this time.) Please understand, this worksheet was created to assist you in obtaining reimbursement for physical therapy services and Think PT cannot guarantee you will receive reimbursement.

  • Deductible: A deductible must be satisfied before the insurance company will pay for therapy treatment. Submit all bills to help reach the deductible amount. 
  • Co-Pay: If you have an office visit co-pay the insurance company will subtract that amount from the percentage they will pay. This will affect the amount of reimbursement you will receive. All Co-pays are due at each PT visit.
  • Reimbursement: The reimbursement percentage will be based on your insurance company’s established “reasonable and customary/fair price” for the service codes rendered. This price will not necessarily match the charges billed; some may be less, some may be more.
  • Referral or Prescription: If your policy requires a referral or prescription from a provider you must obtain one to send in with the claim/provide a copy to Think PT. Each time you receive an updated referral you’ll need to include it with the claim/provide a copy to Think PT. PLEASE NOTE: the state of Michigan is a Direct Access State. DA is a law effective beginning January 1, 2015 that allows anyone within the state of Michigan to see a physical therapist for up to 21 days or 10 treatment visits without needing a prescription from a physician. (In some cases your insurance provider may still require you to get a referral to help with reimbursement, and in these cases Think PT will assist you in this process.)
  • Pre-Authorization: If your policy requires pre-authorization and your insurance company has not given you one yet, you’ll need to call Think PT and ask to request an pre-authorization number prior to your initial physical therapy treatment to ensure reimbursement is possible.
  • Be aware that referrals and pre-authorizations have an expiration date and some set a visit limit. If you are approaching the expiration date or visit limit you’ll need Think PT to submit a request for more treatment.

QUESTIONS TO ASK YOUR INSURANCE COMPANY TO DETERMINE OON/NP THERAPY BENEFITS

Do I have a deductible?        Yes / No

If yes, how much is it? ________________                  

How much has already been met? _________________

What percentage of reimbursement do I get (how much money to I get back from my treatment? (60%, 80%, 90%, are all common) ____________ 

Does the rate of reimbursement change because I’m choosing to see an out-of-network/non-preferred provider?         Yes / No   

Does my policy require a written prescription/referral for Physical Therapy?   Yes / No

If yes, will a written prescription from any MD/physician work or does it need to be a referral from my specialist/Primary care physician?           Yes / No

Does my policy require pre-authorization or a referral on file for outpatient physical therapy services?          Yes / No

If yes, do they have one on file?        Yes / No

Is there a $ or visit limit per year?     Yes / No           If Yes, What is it? _____________ 

Do I require a special form to be filled out to submit a claim?             Yes / No                  How do I obtain it?   ___________________

What is the mailing address I should submit claims/ reimbursement forms to?   _______________________________________________________________________________________________________

Is there an online website where I can submit the claim?       Yes / No             

Web address to submit claims:__________________________________

This worksheet was created to assist you in obtaining reimbursement for Physical Therapy services and is not a guarantee of reimbursement. Think PT is more than happy to assist.