Top 5 reasons we are out-of-network with your insurance…and what that means for you

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I sat down earlier this week to write a piece with the title above, but very quickly realized there really aren’t that many reasons. The only reason we are out-of-network with most insurance plans comes down to one simple fact:

We want to offer physical therapy treatment on our own terms, the way physical therapy was intended to be provided.

Most plans have out-of-network reimbursement. Many people think that if a practice is not in-network with their insurance, they can’t seek services at that clinic. The truth is, in most cases, you can work with a PT who is out-of-network. All it means to be in-network is that a physical therapy provider has signed a contract with a health insurance company that allows the insurance company to decide on the value of the physical therapy provided. Sadly, the current climate of physical therapy insurance reimbursement often has providers being paid less than the cost of a personal training or Pilates session, haircut, or full tank of gas.

A few things you need to understand about physical therapy:

  • We have extensive education, training, and are licensed by the state in which we practice (see The Educated Therapist).
  • All physical therapy is not created equal. PT’s do not receive a handbook on graduation day that tells us how to treat a specific diagnosis. Treatment should be customized, taking into consideration an individual’s activities, lifestyle, home and work demands, and even emotions related to the injury or pain.
  • All physical therapists are not created equal. Some PT’s further their education by taking classes and additional training beyond what is required by our governing board. Some PT’s look for every opportunity to expand their knowledge and stay current with studies and treatments. Good PT’s know that there is not one treatment to help everyone and, while we may not be able to cure all, we have a network of additional resources who might.
  • All components of physical therapy, from hands-on treatment to exercise, should be delivered by physical therapists.

We have chosen to stay true to our ideas of how physical therapy should be delivered. We find that our 45-minute treatment sessions, spent entirely with a physical therapist, help us form relationships with our patients, allow us to address multiple components of pain and injury, and often expedite treatment.

While out-of-network benefits vary, we have discovered that out-of-network reimbursement is often comparable to in-network coverage.


 

What does this mean for you?

We will:

  • provide excellent customer service from the first call.
  • check your benefits and discuss these with you before your first visit so that you have an understanding of the payment and reimbursement process.
  • help you find the best PT fit.
  • follow up with your insurance company on outstanding reimbursements.
  • reimburse you as soon as we receive payment from your insurance company.

What’s different?

  • Your PT may structure a different plan of care than used in traditional PT.  Do you really need 2 times per week for 8 weeks? Maybe not. Your PT will work with you to develop a plan that will help you recover effectively, while keeping in mind schedule and financial concerns.
  • We expect you to be actively involved in your own recovery.  We can’t make you better by ourselves.
  • You will have homework. We may ask you to modify some of your activities (Thought you knew how to sit?? Think again). We make these recommendations not to put a wrench in your lifestyle, but because we know they will help expedite the healing process.
  • We will be available to encourage and support you along the way.
  • You can access your PT via email in between appointments if you have questions or concerns.

Please let us know if we can help you learn more about your physical therapy benefits.  We will gladly call your insurance to verify your coverage and provide you with the information we receive.  We look forward to helping you on your path to recovery!

 

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