Understanding Out-of-Network (OON) Benefits and Reimbursement
Performance Focused Physical Therapy operates as an out-of-network (OON) provider. This means we do not bill insurance directly; instead, patients pay for sessions at the time of service and, if eligible, receive reimbursement directly from their insurance company.
While “out-of-network” can initially sound confusing, many patients are surprised to learn they still have meaningful coverage, especially those with PPO plans. Our goal is to make the process simple, transparent, and easy to understand before you ever commit to an appointment.
Why We Choose an Out-of-Network Model
Being out-of-network allows us to provide care without many of the restrictions commonly imposed by insurance companies. Rather than shorter visits, productivity quotas, or cookie-cutter treatment plans, we can focus on what matters most: delivering high-quality, individualized care.
This means:
One-on-one sessions with your Doctor of Physical Therapy
More time dedicated entirely to you
Individualized treatment plans and exercise programming
Care focused on long-term outcomes, not insurance limitations
Fewer visits and more efficient treatment when appropriate
How Out-of-Network Reimbursement Works
Out-of-network reimbursement varies depending on your specific insurance plan.
Many patients with PPO plans have OON benefits that commonly include:
An out-of-network deductible
A reimbursement percentage after your deductible is met
A “maximum allowed amount” determined by your insurance company
The maximum allowed amount is important because insurance companies often do not reimburse based on what you paid for treatment. Instead, they reimburse based on their own predetermined rate, which may sometimes resemble Medicare’s "participating" or in-network rates.
For example:
You pay for your session → Insurance determines their “allowed amount” → Your deductible and reimbursement percentage are applied → Insurance sends reimbursement directly to you.
Many patients also do not realize that their out-of-network deductible usually must be met before reimbursement begins. If your deductible has not yet been satisfied, reimbursement may initially be lower, or not begin until later in the year.
Reimbursement timelines commonly range from 2–6 weeks after claim submission.
The Easiest Way to Check Your Benefits (Recommended)
We want you to understand your potential costs before booking or confirming your first appointment.
When requesting an appointment through our website or patient portal, you can upload your insurance information directly through our system. We can initiate the an eligibility check process through SPRY PT that allows us to:
Securely collect your insurance information
Run an out-of-network eligibility check behind the scenes
Review your deductible, reimbursement percentage, and benefits
Provide you with a clearer breakdown of your potential coverage
Once we receive the results, we’ll reach out to discuss your benefits and help you understand what your estimated financial responsibility may look like.
This removes much of the guesswork and allows you to make an informed decision before committing to care.
Press Here to request an appointment and to upload your insurance card.
Prefer to Call Insurance Yourself?
You can always call the number on the back of your insurance card and ask:
Do I have out-of-network physical therapy benefits?
What is my out-of-network deductible, and how much has been met?
What percentage is reimbursed after my deductible?
Is there a maximum allowed amount?
How do I submit claims?
How long does reimbursement typically take?