Out-of-Network Reimbursement for PT, Step by Step
How to get your insurance plan to pay you back after paying your PT directly
Updated July 20262 minute read
If your health plan includes out-of-network benefits, you can pay a physical therapist directly, submit a superbill to your insurer, and get reimbursed — commonly 50–80% of the plan's "allowed amount" after you meet your out-of-network deductible. The process takes four steps and usually 2–6 weeks per claim.
Before you start: the three numbers that matter
Out-of-network reimbursement comes down to three plan features — all findable in your benefits summary or one phone call:
- Out-of-network deductible — what you pay out of pocket each year before reimbursement starts. Often separate from (and higher than) your in-network deductible.
- Coinsurance — the percentage the plan pays after the deductible, commonly 50–80%.
- Allowed amount — the price the plan considers "fair" for a PT visit. Your percentage applies to this number, not necessarily what you paid.
The four steps
1. Verify your benefits (5 minutes, once)
Call the number on your card and ask specifically about out-of-network outpatient physical therapy: deductible, coinsurance, visit limits, and whether a physician referral is required for reimbursement (a few plans ask for one even where state law doesn't).
2. Pay your PT and collect superbills
Pay the listed cash price. Ask your therapist for a superbill — RightPT therapists provide them on request. One per visit or a monthly batch both work.
3. Submit the claim
Most insurers accept superbills through the member portal (fastest), a mobile app, or a mailed claim form. Full walkthrough: how to submit a superbill. Watch the filing deadline — plans allow anywhere from 90 days to a year after the visit.
4. Track it and collect
You'll receive an explanation of benefits showing what was applied to your deductible and what's being reimbursed by check or direct deposit.
A worked example
Say your PT charges $150 per visit, your plan's allowed amount is $120, your out-of-network deductible is $500, and coinsurance is 70%:
| Visit | What happens | You're reimbursed |
|---|---|---|
| Visits 1–4 ($600 paid) | First $500 of allowed amounts fills the deductible | $0 (but deductible met) |
| Visit 5 onward | Plan pays 70% × $120 allowed | $84 per visit |
From visit 5, that $150 session effectively costs you $66. Plans differ — run your own numbers with your three figures above.
Keep it honest: what this is and isn't
This is your claim for your reimbursement after paying a therapist you chose. RightPT doesn't bill insurance, verify coverage, or file claims — your relationship with your insurer stays your own, and your relationship with your PT stays refreshingly simple.
Frequently asked questions
Sources (1)
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.