10 Questions to Ask Your Insurance Before Starting Physical Therapy
You’re finally ready to fix that shoulder pain or nagging back issue. You’ve booked your first PT appointment. Everything feels good—until the bill hits. Suddenly you’re stuck with unexpected charges, denied claims, or confusing “EOBs” that make zero sense. Sound familiar?
Here’s the thing: most of that billing stress can be avoided with one simple move—asking the right questions upfront. At PT Billing, we work with clinics and patients every day who had no idea what their insurance really covered until it was too late. So we put together this list of the 10 questions you need to ask your insurance provider before your first physical therapy session.
Let’s break it down in a way that makes sense—and saves you money.
1. Is Physical Therapy Covered Under My Plan?
Start with the basics. Not every insurance plan includes physical therapy, and even if it does, coverage can vary big time depending on your diagnosis, provider, and whether the care is considered “medically necessary.”
Ask: Is outpatient physical therapy a covered benefit on my policy?
2. Do I Need a Referral or Prescription?
Some insurance plans (especially HMOs) require a referral from your primary care doctor or a written prescription from a specialist before they’ll pay for therapy.
Ask: Do I need a referral or pre-authorization before I start PT?
Skipping this step can lead to instant denials—even if everything else is legit.
3. Is My PT Provider In-Network?
Going out-of-network might mean higher deductibles, lower reimbursement, or no coverage at all. Make sure your chosen clinic is part of your insurance network before you show up.
Ask: Is [your PT clinic] in-network with my insurance plan?
If they’re not, call the clinic directly. Some offer competitive self-pay rates that could actually save you money in the long run.
4. What Is My Deductible and Have I Met It?
Your deductible is what you owe out-of-pocket before your insurance starts to pay. Many people don’t realize they have to cover the full cost of their PT visits until that deductible is met.
Ask: How much is my deductible, and how much of it have I met this year?
If you’re early in the year or haven’t had any major medical expenses yet, expect to pay more upfront.
5. What’s My Copay or Coinsurance Per Visit?
Even after your deductible is met, you’ll likely have a set copay (flat fee) or coinsurance (percentage of the visit cost). These vary based on your plan—and they add up fast with multiple visits per week.
Ask: What is my copay or coinsurance amount for outpatient physical therapy?
Knowing this helps you plan financially so there are no surprises at the front desk.
6. Is There a Limit on the Number of PT Visits?
Some plans cap how many visits you can have per year—others require ongoing reauthorization after a certain point. If you go over your limit, you could be footing the bill on your own.
Ask: How many PT visits does my plan allow each year, and do I need re-approval after a certain number?
This is huge if you’re recovering from surgery or managing a long-term condition.
7. Is Authorization Required for Each Visit?
Some insurers require a separate approval for every session. Others approve in chunks—like 6 or 12 visits at a time. Miss this detail and your clinic might not get paid (and guess who gets the bill?).
Ask: Does my plan require ongoing authorizations for PT visits?
8. Are There Any Exclusions or Diagnoses That Aren’t Covered?
Just because you have pain doesn’t mean your plan will cover treatment. Some policies exclude certain diagnoses, pre-existing conditions, or “maintenance care” that isn’t considered medically necessary.
Ask: Are there any conditions or diagnoses that would make my PT treatment ineligible for coverage?
9. Does My Plan Require Treatment at a Specific Facility?
Some plans are super specific about where you can go. Others might have cost-sharing differences depending on the type of clinic (hospital-based vs private practice).
Ask: Are there any location restrictions or facility-type preferences I need to know about?
10. Will I Receive an Explanation of Benefits (EOB) After Each Visit?
Your EOB is the statement your insurer sends showing what they were billed, what they paid, and what you might owe. Reviewing these helps you catch errors or overcharges early.
Ask: How will I receive EOBs, and when should I expect them after each visit?
And don’t ignore them—if something looks off, bring it up ASAP.
Final Thoughts: Be Your Own Advocate
At PT Billing, we always say the same thing: insurance doesn’t have to be confusing—it just requires the right questions upfront. The truth is, most billing headaches don’t come from bad clinics or bad care. They come from gaps in communication and unclear expectations between you, your provider, and your insurance company.
Before you book that next appointment, call your insurer, go through this list, and get the answers in writing if you can. Then, talk to your PT clinic about what you found—because they’ll need that info too.
Want more help decoding your insurance or streamlining your clinic’s billing process? Check us out at physicaltherapybilling.com/ We’re here to make the PT billing world a little less frustrating—and a whole lot clearer.