Celebi & Smith PT PLLC
50 Austin blvd
Commack, NY 11725
Phone: (833) 734-2246
Insurance Benefits Checklist
When calling your insurance company to verify your benefits, ask the following questions:
- Do I have “out-of-network” physical therapy benefits? Yes/No (If yes, proceed to the following questions)
- What is my out-of-network deductible? ________________
- What is my out-of-pocket maximum? _______________
- What is my coinsurance?________________
- Do I have a visit limit? __________________
- Do I need pre-authorization? Yes/No
- If yes, how do I obtain pre-authorization?______________________________________
- Do I need a referral? Yes/No
- How do I submit a claim? _________________________________________________________
What do these terms mean?
- Deductible: The amount of out-of-pocket costs you will need to incur before the insurance plan
will reimburse you
- Out-of-pocket maximum: The amount of out-of-pocket costs you need to incur before the insurance plans cover all services at 100%
- Coinsurance: The percentage of the billed cost of services you owe after insurance plan covers their portion. The representative may state that the plan will cover up to 70%, which means you should expect to get 70% of the cost of the session reimbursed to you in a check.
- Visit limit: The number of therapy visits you have per year. It may be expressed per calendar year or over a different 12-month period. Sometimes it will be “based on medical necessity,” which means there is no limit, as long as the services are deemed medically necessary.
- Pre-authorization: Sometimes, plans require the provider to obtain authorization for certain procedures and over a certain period of time before starting PT services.
- Referral: A physician’s prescription. We have direct access in New York State, which means that you don’t need a referral for the first 10 visits or first 30 days of treatment, whichever comes first. However, some insurance plans still require that you have a referral on file.
If you have any additional questions, please reach out to us via email at
email@example.com or call (833) 734-2246