DURO Health - Physical Therapy and Occupational Medicine

At DURO Health, we prioritize delivering personalized, high-quality care through our cash-pay model. While we don’t bill insurance directly, many patients successfully obtain partial or full reimbursement from their insurance providers. Follow this step-by-step guide to navigate the reimbursement process effectively.

Step 1: Verify Your Insurance Benefits

Before initiating treatment, contact your insurance provider to understand your coverage for out-of-network physical therapy services. Inquire about:

• Out-of-Network Benefits: Confirm if your plan covers services from providers not in the network.

• Reimbursement Rates: Determine the percentage of costs eligible for reimbursement.

• Required Documentation: Identify necessary forms and information for claim submission.

Sample Questions to Ask Your Insurance Provider:

• Does my plan cover out-of-network physical therapy services?

• What percentage of the service cost is reimbursable?

• What specific documentation is required for reimbursement?

Before initiating treatment, contact your insurance provider to understand your coverage for out-of-network physical therapy services. Inquire about:

• Out-of-Network Benefits: Confirm if your plan covers services from providers not in the network.

• Reimbursement Rates: Determine the percentage of costs eligible for reimbursement.

• Required Documentation: Identify necessary forms and information for claim submission.

Sample Questions to Ask Your Insurance Provider:

• Does my plan cover out-of-network physical therapy services?

• What percentage of the service cost is reimbursable?

• What specific documentation is required for reimbursement?

Before initiating treatment, contact your insurance provider to understand your coverage for out-of-network physical therapy services. Inquire about:

• Out-of-Network Benefits: Confirm if your plan covers services from providers not in the network.

• Reimbursement Rates: Determine the percentage of costs eligible for reimbursement.

• Required Documentation: Identify necessary forms and information for claim submission.

Sample Questions to Ask Your Insurance Provider:

• Does my plan cover out-of-network physical therapy services?

• What percentage of the service cost is reimbursable?

• What specific documentation is required for reimbursement?

Step 2: Obtain a Superbill from DURO Health

A superbill is a detailed receipt that facilitates insurance reimbursement. After each session, you can download a superbill from your patient portal on PTeverywhere (https://app.pteverywhere.com). This is the webpage where you booked your appointments.

Your superbill includes:

• Provider information

• Patient details

• Dates of service

• CPT (Current Procedural Terminology) codes

• ICD-10 (International Classification of Diseases) codes

• Service descriptions

• Charges and payments

Please contact us if you need assistance accessing your superbill (holladay.clinic@durohealth.com).

Your superbill includes:

• Provider information

• Patient details

• Dates of service

• CPT (Current Procedural Terminology) codes

• ICD-10 (International Classification of Diseases) codes

• Service descriptions

• Charges and payments

Please contact us if you need assistance accessing your superbill (holladay.clinic@durohealth.com).

Your superbill includes:

• Provider information

• Patient details

• Dates of service

• CPT (Current Procedural Terminology) codes

• ICD-10 (International Classification of Diseases) codes

• Service descriptions

• Charges and payments

Please contact us if you need assistance accessing your superbill (holladay.clinic@durohealth.com).

Step 3: Complete and Submit the Necessary Documentation

Each insurance company has specific claim forms. Below are links to common insurance claim forms:

• Aetna: Medical Claim Form

• Cigna: Medical Claim Form

• Blue Cross Blue Shield: Medical Claim Form

• UnitedHealthcare: Medical Claim Form

Submission Steps:

1. Complete the Claim Form: Fill out all required sections accurately.

2. Attach the Superbill: Include the superbill from your PTeverywhere patient profile account.

3. Provide Proof of Payment: Attach receipts or bank statements as evidence of payment.

4. Submit the Claim: Follow your insurer’s instructions for submission, which may include mailing the documents or uploading them through an online portal.

Each insurance company has specific claim forms. Below are links to common insurance claim forms:

• Aetna: Medical Claim Form

• Cigna: Medical Claim Form

• Blue Cross Blue Shield: Medical Claim Form

• UnitedHealthcare: Medical Claim Form

Submission Steps:

1. Complete the Claim Form: Fill out all required sections accurately.

2. Attach the Superbill: Include the superbill from your PTeverywhere patient profile account.

3. Provide Proof of Payment: Attach receipts or bank statements as evidence of payment.

4. Submit the Claim: Follow your insurer’s instructions for submission, which may include mailing the documents or uploading them through an online portal.

Each insurance company has specific claim forms. Below are links to common insurance claim forms:

• Aetna: Medical Claim Form

• Cigna: Medical Claim Form

• Blue Cross Blue Shield: Medical Claim Form

• UnitedHealthcare: Medical Claim Form

Submission Steps:

1. Complete the Claim Form: Fill out all required sections accurately.

2. Attach the Superbill: Include the superbill from your PTeverywhere patient profile account.

3. Provide Proof of Payment: Attach receipts or bank statements as evidence of payment.

4. Submit the Claim: Follow your insurer’s instructions for submission, which may include mailing the documents or uploading them through an online portal.

Step 4: Follow Up with Your Insurance Provider

After submission:

• Confirm Receipt: Contact your insurer to ensure they have received your claim.

• Monitor the Process: Keep track of the claim status through your insurance company’s online portal or by calling their customer service.

• Address Issues Promptly: If additional information is requested or if there are discrepancies, respond quickly to avoid delays.

After submission:

• Confirm Receipt: Contact your insurer to ensure they have received your claim.

• Monitor the Process: Keep track of the claim status through your insurance company’s online portal or by calling their customer service.

• Address Issues Promptly: If additional information is requested or if there are discrepancies, respond quickly to avoid delays.

After submission:

• Confirm Receipt: Contact your insurer to ensure they have received your claim.

• Monitor the Process: Keep track of the claim status through your insurance company’s online portal or by calling their customer service.

• Address Issues Promptly: If additional information is requested or if there are discrepancies, respond quickly to avoid delays.

Step 5: Appeal a Denied Claim if Necessary

If your claim is denied:

1. Review the Explanation of Benefits (EOB): Understand the reason for denial.

2. Gather Additional Documentation: Obtain any required information or corrections.

3. Submit an Appeal: Follow your insurer’s appeal process, providing all necessary documentation.

DURO Health can assist by supplying additional information or clarifications needed for your appeal.

If your claim is denied:

1. Review the Explanation of Benefits (EOB): Understand the reason for denial.

2. Gather Additional Documentation: Obtain any required information or corrections.

3. Submit an Appeal: Follow your insurer’s appeal process, providing all necessary documentation.

DURO Health can assist by supplying additional information or clarifications needed for your appeal.

If your claim is denied:

1. Review the Explanation of Benefits (EOB): Understand the reason for denial.

2. Gather Additional Documentation: Obtain any required information or corrections.

3. Submit an Appeal: Follow your insurer’s appeal process, providing all necessary documentation.

DURO Health can assist by supplying additional information or clarifications needed for your appeal.

Contact Us

By following these steps, you can navigate the reimbursement process more effectively. DURO Health is committed to supporting you throughout this journey. If you have any questions or need assistance, please don’t hesitate to reach out holladay.clinic@durohealth.com or (801) 835-6740.