Out of Network - Expert Manual Therapy

Out of Network (Patient info)

Expert Manual Therapy is accepting out-of-network with all insurances at this point of time and does not submit claims for reimbursement to insurance companies. But it is usually helpful to you if we know what type of insurance you have in case you need our help navigating your benefits when asking your insurance for reimbursement. We will gladly help guide you through the process of getting direct reimbursement from your insurance company.

Please note that you are not required to submit claims to your insurance company for services we provide and it’s your choice as to whether you want to be reimbursed.

Questions to ask your insurance company – If you’re hoping to request direct out of network reimbursement for Physical Therapy (Rehabilitation only) services.

What type of insurance do I have? HMO, Medicare, Medicaid, PPO

If you have an HMO, Medicare, Medicaid, out-of-network services are not likely to be reimbursed.

Note: Medicare specifically will not allow you to see out- of- network providers for PT, unless it is for services that would not otherwise be covered by Medicare. Contact CMS for more information

What does my specific policy state regarding reimbursing out-of-network care? What services and tests are covered by my plan?

Will they be covered if performed by an out-of-network provider? What services or tests are excluded?
Do I have an out-of-network deductible, co-insurance, etc.?

And if so, what percentage will my insurance pay, and what percentage will I have to pay? What are the rules for accessing care outside my plan’s network?

Do I need Prior Authorization from my insurance company for Physical therapy?

For example, sometimes a service or test needs to be pre-authorized (pre-approved) and your insurance company will tell you up front how many visits they will cover and the time frame you can receive services in.

If prior authorization is needed, the form will usually be on your specific insurance company’s website and we will fill it out for you.

How do I submit my claim to my insurance company?

Often this information is on the insurance company’s website, and can often be done online or mailed in. Make sure to include your receipts from us with your claim and to tell them to send reimbursement directly to you and not us!

This is information you want to know prior to starting Physical Therapy and it will be your responsibility to contact your insurance provider to obtain it. If you find out prior authorization (pre-approval) is needed, please let us know prior to beginning PT and we would be happy to apply for prior authorization on your behalf.

Please feel free to ask questions and let us know if you need any added documentation for your direct reimbursement. We are here to help you through this process.