Have PPO Insurance?
You May Have Options.
We're an out-of-network physical therapy practice. Depending on your plan, you may qualify for reimbursement—and we're happy to help you explore your benefits before getting started.
Insurance doesn't have to be complicated.
Our goal is simple: help you understand your options while you focus on getting better. You pay for your sessions directly; eligible out-of-network services may qualify for insurance reimbursement.
Ask us
Send a quick inquiry about your insurance. No member ID or insurance card needed yet.
Explore your benefits
We'll follow up about options for a detailed benefits check before your first visit.
Get back to what you love
Receive one-on-one care. After each visit, choose how you'd like to get reimbursed—we file for you, or you file yourself.
Two easy ways to use your out-of-network benefits
You pay $180 per session at your visit. Then pick the option that works best for you.
We submit your claims for you
The easiest way. We send your claims to your insurance after each visit, so reimbursement goes straight to you.
- No paperwork or forms for you
- Claims sent after every visit
- We help with insurer questions
- No extra fee—included with your care
Superbill — you submit it
Prefer to handle it yourself? We give you a superbill: a detailed receipt with everything your insurance needs.
- Includes diagnosis and treatment codes
- Submit online or by mail to your insurer
- You stay in full control of timing
- Also free
Either way, your insurance company sends any reimbursement directly to you.
Want help understanding your insurance?
Tell us how to reach you and which insurance company you use. We'll contact you to discuss the next steps for checking your out-of-network physical therapy benefits.
No commitment to book. This is an inquiry—not an instant insurance verification or reimbursement quote.
We won't ask for your insurance member ID, date of birth, medical history, or a photo of your insurance card here. If a detailed check is appropriate, we'll direct you to a secure verification process.
Request a Benefits Review
Takes about a minute. No insurance card or member ID needed.
Why choose out-of-network physical therapy?
More personalized care. More attention. A treatment plan built around you.
At Carmel Physical Therapy, we take the time to understand your injury, your goals, and how you move. Being out-of-network gives us flexibility to structure appointments around your needs rather than an insurance-driven visit model.
One-on-one, every visit
Your full appointment is dedicated to you and your licensed physical therapist—no aides, overlapping appointments, or double-booking.
Time for the whole picture
Full-length sessions allow time for assessment, hands-on care when appropriate, exercise, and movement retraining.
Built around your goals
Whether you want to return to running, lifting, sports, or everyday activities, we adapt your plan as you progress.
From recovery to performance
We focus on building strength, confidence, and long-term capacity—not just short-term symptom relief.
How out-of-network benefits work
Many PPO plans pay part of the cost when you see a provider outside their network. HMO and EPO plans usually don't. Three terms tell you most of what you need to know:
Deductible
The amount you pay each year before insurance starts sharing costs. Many plans have a separate out-of-network deductible.
Coinsurance
After your deductible, the percentage your plan pays—often 50–80% for out-of-network care.
Allowed amount
The price your insurer decides a visit is worth. It can be lower than what you paid, and it's what your coinsurance is based on.
Example: after your deductible is met
For illustration only. Your numbers depend on your plan.
Haven't met your deductible yet?
Submitting claims still helps. Each eligible visit counts toward your out-of-network deductible, so you can reach the point where your plan starts paying sooner.
That's why we recommend submitting a claim for every visit, even early in the year.
Skip the insurance phone calls—we'll check for you
Send us a quick benefits review request and we'll help you find out:
- Whether your plan has out-of-network physical therapy benefits
- Your out-of-network deductible and how much you've met
- What percentage your plan may reimburse
- Any visit limits, referral, or pre-authorization requirements
Good to know
Do PPO plans cover out-of-network physical therapy?
Many PPO plans include out-of-network benefits, but coverage varies. We can discuss options for verifying your specific plan.
Can visits count toward my deductible?
Eligible claims may count toward your applicable out-of-network deductible, even if you don't receive immediate reimbursement. Some plans have shared deductibles; others have separate in-network and out-of-network deductibles. Your insurer determines the amount credited.
Will you submit claims to my insurance?
Yes, at no extra cost. You can have us submit out-of-network claims after each visit, or we can give you a superbill to submit yourself. Reimbursement is determined by your insurer.
What is a superbill?
A detailed receipt that lists your visit date, diagnosis and treatment codes, and our provider information—everything your insurance company needs to process an out-of-network claim.
Do I need a doctor's referral?
In California you can usually start physical therapy without a referral. Some insurance plans still require one for reimbursement, so it's worth asking your insurer.
Can I use HSA or FSA funds?
We accept HSA/FSA payments for eligible physical therapy services, subject to your plan and applicable rules. General fitness and wellness services aren't automatically eligible.
Is reimbursement guaranteed?
No. Your insurance company determines eligibility, allowed amounts, deductible credit, and any reimbursement. A benefits check is not a guarantee of payment.
Ready to move forward?
Let's talk about your goals and whether Carmel PT is the right fit.
Book a Free Discovery CallCarmel Physical Therapy is an out-of-network practice. Payment is due at the time of service. Insurance reimbursement and deductible credit depend on your plan and are not guaranteed. Medicare and other government programs may have different billing rules. Benefits inquiries do not constitute insurance verification.