Insurance Coverage & Billing

Frequently asked questions

Some insurance plans require a referral in order to be seen by a Physical Therapist. A referral is a document that you request from your primary care physician (PCP) stating the medical need for the involvement of another practitioner or specialist other than your primary care physician (PCP). A quick phone call to your physician’s office will usually take care of this.
Our fax number is:
New York City & Long Island: 646-893-5183
Minnesota: 763-260-7653

A physical therapy prescription/script/order is a written order from a medical provider that prescribes physical therapy treatment. In some cases, you are able to seek care from a Direct Access eligible physical therapist for a limited duration without a prescription. If your plan of care extends beyond that, you will need to obtain a prescription in order to continue with treatment.

Direct Access is a law that allows patients to seek treatment from a physical therapist without a referral or prescription from another medical provider for a duration. Not every physical therapist is eligible for Direct Access, so if you choose to be seen through Direct Access, call and check that your desired provider will be able to treat you under this law.

New York State physical therapists are able to treat patients without a referral for 30 calendar days OR 10 sessions, whichever comes first.

Minnesota physical therapists are able to treat patients without a referral for up to 90 calendar days.

Authorization is the determination that a service is medically necessary, made by an insurer of a health care service, generally before the service is rendered. This approval is required in order for the insurer to cover the service. If authorization is needed, our dedicated authorization team will work directly with your insurance company. In many cases, multiple rounds of authorization requests need to be made to carry out a full plan of care. The determination is made by a medical reviewer from your insurance company, and the approved number of sessions may not always coincide with what your physician or physical therapist recommends.

Orthology will verify your coverage and we encourage you to check your benefits with your insurance company as well. It is the responsibility of each individual to be informed of their own insurance benefits. Your insurance will be billed for the services rendered during the appointment. Once the claim is processed, your insurance will inform us of any patient responsibility. If the explanation of benefits (EOB) from your insurance states an amount due as patient responsibility, a statement will be sent of the amount indicated by your health insurance.

Orthology clinics are a part of ProHEALTH, which is rebranding to Optum Tri-State. By aligning under the Optum name, we are making it easier for you to find care, resources and services throughout the tri-state region. Together, we are a unified team, focused on delivering care to help you achieve better health. As part of this change, our billing systems and processes are managed by our partners at ProHEALTH/Optum. If you have a question about your bill, please give us a call.

For New York City and Long Island payments: Click here
For Minnesota payments: Click here