We are an out-of-network physical therapy provider. However, you can call your insurance company to check your benefits! Here’s how:

1. Call the toll free number on your insurance card.

2. Select the option that will allow you to speak with a customer service representative. Please DO NOT use the automated system.

3. Ask the customer service representative to quote your outpatient, out-of-network physical therapy benefits. This is frequently termed “rehabilitation benefits.”

Specific Questions to Ask:

1. Make sure you get the name of your representative. Write it down with the date of your call.

2. Do I have out-of-network benefits for physical therapy? ____ Yes. _____No.

3. Do I have a deductible? _____Yes. _____No.

4. If I do, what is it? __________

5. How much has already been met? _________

6. Do I have per calendar year plan or a per benefits year plan? ____per calendar _____per benefits

7. If I have a per benefit year plan, what are my dates of coverage? ____________

8. Does my policy require a written referral or prescription?

   1. If yes, a written prescription from ANY provider (i.e., physician, nurse practitioner, podiatrist, chiropractor?)

   2. If no, does it have to come from a PCP (primary care physician)?

      1. What is the name of the PCP on file?

9. Is pre-authorization required for physical therapy services? _____ Yes _____ No

   1. If yes, do I have one on file?

   2. What is the expiration date?

10. Is there a dollar limit or visit limit per year? _____ Yes _____ No

11. Do I require a special form to submit a claim? _______ Yes _____No

    1. If so, how do I obtain it?

12. What is the mailing address where I should send my claim or reimbursement form?

13. Can I submit my claim online? ______ Yes ______ No