Check the back of your insurance card for a contact number. When you call ask if you have out of network benefits for physical therapy. If you do ask the following questions:

1. Do I have an out of network deductible? (Most services will not be reimbursed until the deductible is met.) If yes:

   1. How much is the deductible? $_________

   2. How much has already been met? $_________

2. What percentage of reimbursement do I have for a non-preferred or out of network provider? _____%

3. Does my policy require a written prescription for outpatient physical therapy services? ____ Yes ____ No

4. Does my policy require pre-authorization for outpatient physical therapy services? ____ Yes ____ No

5. Is there a cost or visit limit per year? ____ No ____ Yes $______ or ______ visits

6. Is there a special form to be filled out to submit a claim? ____ Yes ____ No

   1. How do I obtain it? ___________________________

   2. What is the mailing address I should use to submit claims? _________________________________________________________

7. Is there an online website where I can submit the claim? _______________________

8. How long does it take to review the claim & reimburse? ________________________

9. Is there anything else I need to know to see an out of network provider? ___________________________