Out-of-Network: 

When we work for the patients, and not the insurance companies.

REFERRALS:

Did you know?  California is a direct access state, which allowed a licensed physical therapist to provide services for 45 days or 12 visits, whichever occurs first, without a doctor’s referral.  This means you can choose a specific therapist based on your baby’s needs instead of based on your doctor’s institution. After that limit has been reached, and if therapy continues to be necessary, the physical therapist may continue to see that patient only after receiving a signed plan of care or a medical prescription.   If therapy is deemed necessary at your baby’s first evaluation, we send along a prescription request right away because we want your baby’s entire care team to be on the same page about her development.

REIMBURSEMENT:

We are a fee-for-service, direct-pay therapy practice that is not “in-network” with any insurances.  Payments are due upfront.  Depending on your insurance, you may be eligible for reimbursement for your “out-of-network” physical therapy services. Upon request, receipts can be provided that include the necessary codes to send reimbursement-claims to your insurance company.  They will then choose the amount to reimburse you. Each plan varies, so you should review your policy specifics before your first session, but typically an “out of network (OON) provider” is compensated at a percentage of shared cost.  This means that your insurance provider will pay a percentage of the cost and you will be responsible for a percentage. 

As every insurance plan is different, we recommend using this checklist of questions to find out more about your specific plan:

TOP 4 QUESTIONS to ask your insurance provider regarding your out-of-network benefits for physical therapy:

1. Do I have out-of-network physical therapy benefits? If not, what does that mean?
2. Am I eligible to receive direct reimbursement from the insurance company for my physical therapy visits?
3. What percentage of the money I paid at my physical therapy visit will you, the insurance company, reimburse me (the patient)?
4. Do I have an out-of-network deductible to meet first?

OTHER WAYS TO SAVE:

Employer flex plan: If your employer offers a flex plan, you can elect to put away funds to pay for treatment with tax-free dollars, providing a substantial savings.

Purchase pre-pay bundles: If you choose to pay for several sessions in advance, whether it’s three or more, you can receive a discount.

Even if you have no out of network benefits, or just want to pay with cash and avoid the hassle, the value still benefits you and your baby!  Check out “Evidence In Motion” to read more about why direct-pay physical therapy benefits both therapists and patients.

 

If you want to know more, please email us directly!  We are happy to answer any questions that you have about direct-pay physical therapy!

Dr. Judy. J. Wang, PT, DPT

Board-Certified Clinical Specialist in Pediatric Physical Therapy

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Tel: 818-937-3699

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