Out-of-Network Benefits:

• Call your insurance company: This is the first and most crucial step. Understand your specific plan's out-of-network benefits for physical therapy. They will tell you:

  • Reimbursement rate: What percentage of the physical therapist's fee will your insurance cover?

  • Deductible: How much do you need to pay out-of-pocket before insurance kicks in?

  • Maximum coverage: Is there a yearly or per-session limit on your out-of-network coverage?

• Ask the physical therapist for an estimate: Your PT should share EXACTLY the cost to deliver your services whether thats per visit or per solution. At Rethink PT, I prefer charging by solution because finding the solution to pain or dysfunction is hopefully your goal.

• Compare costs: Calculate your estimated out-of-pocket cost after insurance reimbursement considering your deductible and coverage limit.

• Submit claims: Keep all receipts and invoices from the physical therapist. Once you've reached your deductible or used all your allotted coverage, submit claims to your insurance company for reimbursement.

FSA (Flexible Spending Account):

• Check your plan's eligibility: Verify PT coverage, I have yet to find an employer’s plan which does not include PT services

• Submit claims: Use your FSA debit card or submit claims like you would with regular insurance. Remember, FSA funds expire at the end of the year (or grace period), so plan accordingly.

HSA (Health Savings Account):

• HSAs offer more flexibility, covering qualified medical expenses, including physical therapy.

• Keep detailed records: Maintain receipts and invoices for tax purposes.

• Track contributions: Remember that HSAs have annual contribution limits.

Additional Tips:

• Negotiate with the physical therapist: Some therapists might offer discounts, others will not. Be prepared to 'get what you paid for’

• Explore payment plans: Ask if the physical therapist offers installment plans to make the cost more manageable.

• Consider in-network options: If out-of-pocket costs are high, compare the benefits and costs of seeing an in-network physical therapist first before working with an out of network provider.

This is general information. It's crucial to consult your specific insurance plan and HSA/FSA provider for accurate details regarding coverage and reimbursement procedures.

Keep being awesome!

All the best, David