What is out-of-network coverage?
Insurance can be so confusing. We want to help you take the mystery out of it so you can be your most empowered.
Step 1:
Find out what your out-of-network coverage is.
- Grab your insurance card. If your card states PPO or POS, call the number on the back. Be ready to read out some of the numbers on the front of the card. If your card says HMO, you likely do not have out-of-network benefits.
- Ask the following questions:
- “Do I have out-of-network coverage for Pelvic Floor Physical Therapist?” This question will tell you whether or not out-of-network therapy is covered by your insurance plan.
- Does your policy require a written prescription from your primary care physician?
- Does your policy require pre-authorization or a referral?
- “What deductible do I need to meet before you will start reimbursing?” This will tell you how much you need to pay out of pocket before they will start paying you back for some of the session cost. Deductibles vary widely. Some people might have a deductible of $250 where someone else will have a deductible of $8,000. Either way, this is super helpful to know because they will start paying you back once you reach that mark. Even if you weren’t originally planning to use insurance, it might still be worth working towards meeting your deductible so you can get money back when you meet that amount.
- “What percent do you cover?” It could be more or less, but the answer is often 50-80% of what they call “allowable” reimbursement. Basically, every insurance company has this secret number of what they will cover. Why? Insurance has their way of setting up their systems, so we can’t answer that for you, but at the end of the day, you’d still be cutting your cost for Pelvic PT sessions down, once you receive your reimbursement.
Step 2:
Download the Reimbursify app here.
- We’ve found the Reimbursify app to make things as easy as possible for you (they do charge $2.99 a claim), but you can always contact your insurance company to learn their unique process to submit an out-of-network claim.
Step 3:
Tell the receptionist you need a “superbill”
- You will then receive a document called a “superbill”. This is basically a special kind of invoice that lists specific information on the type of service you received, by which clinician, and with what diagnosis. You can’t be covered by insurance without a diagnosis that they are willing to cover for. Your therapist can talk to you privately about what diagnosis would fit your experience.
Step 4:
Upload your superbill to Reimbursify. It takes about 2-ish minutes.
- Hooray for Reimbursify! They will make everything super easy for you. Once you upload a superbill for the first time (it takes about 2-5 minutes), you’re set.
- After submitting for the first time, you can just click “clone” or duplicate and it’ll cut your submission time down to about 30 seconds.
NO MORE STEPS!
You’ve now learned how to submit out-of-network benefits. Once you hit your deductible, your insurance company will start mailing reimbursement checks to your mailing address.