Confused About My Physical Therapy Billing... Help?

Seeking Help
1

I have pre-auth approval for physical therapy sent in the mail by my insurance provider. They said the physical therapy clinic I chose is in network and approved, with the address even included. But my insurance denied it saying the PT clinic is out of network. The PT office called me back and sent me a confirmation email saying I’m indeed in network and approved. But my insurance is still denying it.

2

Thank you for sharing your situation. To better help you, can you please tell us your age, state, and estimated gross income? Also, have you received an Explanation of Benefits (EOB) from your insurance that might shed some light on this issue?

3

Try contacting state regulators if you’re having ongoing issues. Look up ‘health insurance oversight’ on Google with your state name included. They may be able to help resolve your situation quickly.

4

When did you receive the pre-auth approval? Was it at the end of last year and are you seeing the PT clinic now? Sometimes contract statuses for providers can change, so it might be an issue like that.

5

@Palmer
I received pre-auth approval on Jan 26th of this year, just after my physical therapy evaluation. I’ve already hit my out-of-pocket max, too.

6

Aza said:
@Palmer
I received pre-auth approval on Jan 26th of this year, just after my physical therapy evaluation. I’ve already hit my out-of-pocket max, too.

Based on what you mentioned, it doesn’t seem like it’s an issue with my initial thoughts. You might want to reach out to your state’s insurance department for assistance. They can help regulate and monitor your insurance company.

7

Have you considered filing a complaint with your state’s Department of Insurance? Also, can you check your online insurance portal if the PT clinic is listed in the directory? If so, take a photo of it.

8

@Adler
I’ll do that. But my insurance portal is weird and doesn’t directly send me to the PT clinic. I did type in the address, though, and it doesn’t show up. Still, I have the paperwork from the mail and the email from the PT office confirming it’s in network.