Insurance Coverage

Most PPO plans reimburse out-of-network physical therapy services to some degree — often 50–80% of the cost once your deductible is met. If TVPT is not in your network, that does not mean you are out of options. Here is how the process works:

Step 1: Check Your Benefits. Call your insurance provider and ask about out-of-network physical therapy coverage. Find out your deductible, your reimbursement rate, and whether a referral or prior authorization is required.
Step 2: Get Your Superbill. We provide a detailed, itemized receipt containing all the necessary diagnostic and treatment codes. You can request this session by session or on whatever timeframe works for you.
Step 3: Submit and Get Paid. Upload the Superbill to your insurance portal or mail it in. Your insurer sends the reimbursement check directly to you.
Step 4: Use Your HSA or FSA. Health Savings Account and Flexible Spending Account funds can be used to pay for all TVPT sessions, making your care tax-advantaged.

Patient Checklist: Calling Your Insurance

Before you call, have your insurance card and a pen ready. Call the member services number on the back of your card and ask to speak with a representative about your out-of-network outpatient physical therapy benefits. Here are the essential questions to ask:

Do I have out-of-network benefits? If not, you can still see us — but your plan will not contribute to the cost. We offer payment plans and package options because your care comes first.
What is my out-of-network deductible, and how much have I already met this year? This is separate from your in-network deductible.
What is my reimbursement rate or coinsurance? Common rates are 60%, 80%, or 90% of the allowable amount.
Is there a visit limit per year? Some plans cap physical therapy at 20 or 30 visits per calendar year.
Do I need a physician referral or prior authorization? Oregon is a direct access state, but some plans still require a referral or authorization to process a claim.
How do I submit a Superbill? Ask whether there is an online portal or a mailing address for member-submitted claims.

Pro Tip: Ask the representative for a reference number for the call. This is helpful if there is ever a dispute about what you were told.

Out-of-Network Call Script

The Intro: "Hi, I am calling to verify my outpatient physical therapy benefits. I am planning to see an out-of-network provider. Can you tell me what my coverage looks like for this?"

The Specifics: "I need to know my out-of-network deductible and what percentage of the allowable amount you cover once that deductible is met. Is a physician referral or prior authorization required for reimbursement?"

The Closing: "Thank you — could I get a reference number for this call and the name of the representative I spoke with?"

Medicare Part B

Medicare Part B typically covers outpatient physical therapy services that are considered medically necessary to treat an illness, injury, or condition — including post-surgical recovery, injury rehabilitation, and treatment of chronic pain, provided the care meets Medicare's medical necessity standards.

Important: Medicare does not allow cash payment for services that could be covered under Part B. Even with a physician's prescription, we cannot accept out-of-pocket payments from Medicare beneficiaries for Medicare-covered treatments.

Limited Exceptions

Patients may self-pay for services that are clearly non-covered, such as general wellness or fitness programs not classified as traditional physical therapy.
Patients may also pay for therapy services that exceed the annual threshold (currently $2,480 in 2026), provided those services are documented as medically necessary and billed according to Medicare's fee schedule.

How We Help

We verify your Medicare coverage and ensure all services meet Medicare's documentation and billing standards.
We coordinate with your referring provider when needed.
We help you understand your coinsurance responsibilities (typically 20%) and whether secondary insurance such as Medigap applies.

Note: We are out-of-network with Medicare Advantage (Part C). We strictly follow all Medicare rules to protect your benefits and maintain full legal compliance. If you are unsure whether your situation qualifies, call us at (971) 238-5755 and we will walk you through your options.

Workers' Compensation

In Oregon, workers' compensation insurance provides benefits to employees who suffer work-related injuries or illnesses. Here is how the process works from injury to recovery:

Initial Steps and Reporting

Report the Injury. Report your work-related injury or illness to your employer as soon as possible. Delays can affect your eligibility for benefits.
Employer Files the Claim. Your employer will file a claim with their workers' compensation insurance carrier and provide you with a claim form (Form 801) to complete and return.
Medical Examination. Visit an authorized medical provider to assess your condition and determine whether physical therapy is part of your treatment plan.
Referral and Authorization. If your authorized provider prescribes physical therapy, you may choose where you receive care, as long as the clinic is an authorized workers' comp provider. In Oregon, you do not need a separate referral from your primary care physician. Your insurance carrier must authorize the treatment plan before sessions begin.

Treatment and Coverage

Treatment Plan. Once authorized, we develop a personalized treatment plan focused on your recovery and return to work. Progress is documented and reported to your medical provider and the insurance carrier.
No Out-of-Pocket Costs. Workers' compensation covers all approved treatment costs, including any necessary equipment. The insurance carrier pays providers directly — you should not incur out-of-pocket expenses for approved care.
Ongoing Adjustments. Your plan is regularly reassessed and adjusted based on your progress and any additional medical evaluations.
Return to Work. Your physical therapist will work with your medical provider to determine when you are ready to resume full or modified job duties.

Disputes and Appeals

Dispute Resolution. If there is a disagreement about the necessity or extent of your therapy, both you and the insurance carrier have the right to request an independent medical examination or a hearing before the Oregon Workers' Compensation Board.
Appeals Process. If your claim is denied or you disagree with an insurance decision, you have the right to appeal by filing a request for a hearing with the Workers' Compensation Board.

Understanding the process and knowing your rights helps ensure you receive the care you need. Promptly reporting injuries, following up with authorized providers, and staying current on paperwork are key to a smooth experience.

Workers' Comp FAQ

Do you treat workers' comp injuries in Hillsboro? Yes. We treat a wide range of job-related injuries for patients throughout Hillsboro and the Tualatin Valley.
Is a referral required? Yes. Oregon requires a referral from a physician or nurse practitioner to begin physical therapy under workers' comp.
Do I need a claim number to start? Often, yes. If you have not received one yet, we can walk you through what information is typically needed and how to proceed.
What should I bring to my first appointment? Your claim number, adjuster contact information, date of injury, employer information, and any work restrictions.
Will you communicate with my adjuster or case manager? Yes, with your permission. We can provide documentation and progress updates as needed.
Can PT help me return to work safely? Absolutely. Treatment is designed to restore function and build the physical tolerance your job requires.
What if I have flare-ups during recovery? That can happen. We adjust loading, update your home program, and teach strategies to manage symptoms while keeping progress moving. Setbacks are feedback, not regressions.

Oregon Personal Injury Protection (PIP) insurance is included in all Oregon non-commercial auto insurance policies. It provides no-fault medical, wage-loss, and essential service coverage regardless of who caused the accident. In the event of an auto, bicycle, or pedestrian accident, your auto insurance guarantees $15,000 in medical coverage over a two-year period and extends to all occupants, pedestrians, and cyclists involved. If you do not have auto or health insurance, the at-fault driver's insurance should cover your medical expenses.

Initial Steps After an Accident

File a claim with your auto insurance. Do this even if the other party is at fault. Your insurer will bill theirs on your behalf.
Seek emergency care if the collision was severe. Go to the Emergency Department or Urgent Care if any of the following apply:
Airbags deployed
You lost consciousness at any point
Changes to vision, hearing, ability to swallow, or speech
Sudden severe headache, dizziness, or nausea/vomiting
New difficulties with concentration, memory, or light/screen sensitivity
Intense numbness, tingling, or weakness — especially in the face, saddle area, or down both arms and/or legs
An EMT, paramedic, or other medical professional recommends it
Get cleared before starting outpatient care. If you go to the ER or Urgent Care, you must be cleared for physical therapy before beginning treatment.
Otherwise, you can begin recovery the same day. TVPT offers same-day appointments — most other clinics have waits of days to weeks.

Next Steps

Contact your chosen healthcare provider. At TVPT, we often work alongside chiropractors, massage therapists, and acupuncturists. We can refer you to complementary providers near your home or workplace. No referral is required to start care at TVPT, but coordinated care tends to produce better outcomes.
Prioritize active recovery. Passive treatments may reduce pain short-term, but active physical rehabilitation is what drives long-term recovery and prevents recurring issues.
Stay current on your claim and all required insurance paperwork.
Ask questions. Every medical professional should be able to explain what they are doing, why, and how it helps you.

Auto/PIP FAQ

Am I limited in choosing my provider? No. You are free to choose your healthcare providers. PIP is obligated to cover reasonable and necessary treatments of your choice.
What does PIP cover? Within two years, PIP covers up to $15,000 in medical expenses, wage loss, and loss of essential services up to $30 per day. Coverage extends to all car occupants, pedestrians, and cyclists struck by a vehicle.
How much wage loss will PIP pay? PIP covers 70% of lost wages if an accident causes a disability lasting at least 14 days, up to $3,000 per month for up to 12 months.
Will my insurer pay all my medical bills? Insurers are required to pay reasonable, accident-related medical expenses within two years, but they may deny payment or send you to an insurer-selected physician who disputes the necessity of treatment.
What if my expenses exceed my PIP coverage? If you are not at fault, you may have access to up to $30,000 in combined coverage through both your and the other driver's auto insurance. A personal injury attorney can assist if you are having difficulty.
What can I do if my insurer refuses to pay? If not at fault, pursue the at-fault driver's insurance. If at fault, you can sue or request arbitration with your own insurer. A personal injury attorney can help in either case — it is advisable to consult one before your benefits are exhausted.
How can I reduce the likelihood of a PIP denial? Seek treatment from licensed medical professionals — PIP is less likely to deny bills from MDs, DOs, DPTs, or DCs.
Do I have to repay my insurance company for PIP benefits? Rarely. Repayment depends on legal action, and attorneys often negotiate with insurers to waive repayment obligations as part of settlement agreements.

If you do not have applicable insurance coverage — or if you simply prefer to skip the insurance process altogether — TVPT offers straightforward self-pay services. Eliminating the third-party billing layer means less paperwork, faster care, and no surprise bills.

We are happy to discuss rates over the phone or in person during your first visit. We also offer payment plans and package deals to make consistent care as accessible as possible, because your recovery should not be derailed by financial barriers.

Additionally, Health Savings Account (HSA) and Flexible Spending Account (FSA) funds can be used for all TVPT sessions, making self-pay a tax-smart option for many patients.

Not sure if self-pay is right for you? Schedule a free 15-minute phone consultation and we will help you figure out the best path forward.