Updated: May 27, 2019
Physical Therapists who have decided to go Out of Network are NOT in network providers with your insurance company. This means that they will not bill your Insurance company directly.
Most insurances however DO have out of network coverage for physical therapy. At your appointment with an out of network provider you will pay for your PT session the day of service and given the documentation and receipt necessary to file a claim for reimbursement with your insurance company.
High deductibles for many patients make it feel like you are paying out of pocket in an in network clinic who are billing your insurance company directly.
Why do therapists go out of network?
Local reimbursement for outpatient PT services is one of the lowest in the country. This causes an in network PT provider to need to see multiple patients at one time.
A Physical Therapist who is out of network is not under the same stringent constraints from insurance companies, and therefore is able to focus on one patient for a dedicated period of time to provide individualized care.
Statistics show that 1:1 physical therapy care results in fewer PT visits overall
Do I still need a script to come to an out of network PT?
New York State allows you to come to see a physical therapist for 30 days or 10 visits without a MD script. This is called Direct Access.
If you need PT after that period of time your Physical Therapist will request a script from your doctor to continue your care. A Wellness visit with your Physical Therapist is not considered a Physical Therapy session and does not apply.
References: Get PT1st http://getpt1st.com/