Why See An Out-Of-Network Physical Therapist?
First off, what is an out-of-network physical therapy practice? It is a practice which does not accept insurance.
This sentence in and of itself usually stops people from even considering care. If you think about it simply - you are paying a lot of money each month for insurance, why wouldn’t you just use it?
Well, it just depends on the experience you want and what feels right for you. Let’s dive into the differences, as I have worked in both worlds… and let’s just say, there is a reason I started and out-of-network clinic.
Let’s dive into what traditional in-network physical therapy looks like:
You walk into an in-network physical therapy clinic and have an evaluation. The front desk staff can only tell you how much your copay is going to be and will give you a general range of the potential cost of care for each visit, but not the exact cost of care since it will change dependent on the services provided by the physical therapist. Also, each insurance has its own rules. For example, some insurance companies restrict how many visits you are “allowed,” which diagnosis codes are covered/which are not (and they are constantly changing), and what treatments /services are covered. This can limit the physical therapist on what treatment they provide. For instance, I dry needle and this service is typically not covered by insurance, so you may have to pay out of pocket for this service or not be able to get the service at all. At the end of your care, you are “discharged”… and 6months later you get a bill for the care you received.
So there are a few problems with this scenario:
It’s confusing.
You don’t actually know the cost of your care. You know your copay- but do you know what the final bill is going to be when all is said and done? No.
The insurance companies dictate what the provider can do for each patient, in terms of the types of services permitted and the number of visits allowed.
The physical therapist can ONLY treat the diagnosis code provided … and NOTHING ELSE. You come in with a diagnosis for foot pain and as you talk more you also want the therapist to treat your shoulder pain? They would have to open another case and treat it separately.
Since insurance companies typically reimburse the in-network provider a small amount for each visit, in order to keep the doors open, therapists are required to see as many patients as they can in a day. This creates a “factory like” environment, where a physical therapist is in charge of multiple clients at the same time or are taught to put you on a bike for 15mins prior to the session and an ice pack/cold pack after each session to get a little extra money. They are coached to keep you there for a certain amount of time if you have a certain insurance to maximize what they can get from your insurance. In staff meetings, physical therapists are literally taught how to “maximize billing” for each insurance.
To get reimbursed there are specific documentation requirements so, you understandably see insurance based clinicians stuck on their computers and not connecting with you.
Personally speaking, the burnout is REAL.
What are the benefits of going to an out-of-network clinic?
Transparency: No unexpected bills months after your appointments.
Individualized care. You can ALWAYS expect one-on-one care. If you are considering going to an in-network clinic you should ask the administration team, “ Do I get one-on-one care and if so FOR HOW LONG?” ESPECIALLY if you are searching for pelvic health support.
Greater continuity of care. You work with just me… no aides, not assistants. So you don’t have to tell your story multiple times.
Direct Access: Even though Ohio is a direct access state, some insurances still require a script from a physician. This means you have to see your MD before you see a PT. The wait becomes longer. Going out of network eliminates these unnecessary delays.
More freedom to address multiple issues and use all the “tools in my toolbox.” I don’t have to limit your care based on your insurance… I can provide you my full skill set without worrying if insurance will reimburse.
Can focus on wellness & prevention. We can go beyond symptom resolution and we can add to your bodies resilience.
To be honest, I often work with people who have been to insurance based care, and been frustrated. So then they come to me seeking a different experience. Out-of-network we can dive into a full body treatment approach and make each session successful for you… whatever that means to you on that day.
STILL HAVE QUESTIONS? Check out the FAQs.
SO, if you have tried the insurance based route and been frustrated and you’re interested in a holistic approach to treatment, I offer 1 on 1 treatment in Columbus, OH.
Schedule your free 15min phone consultation!
In health,
Emma Lengerich PT, DPT, OCS, CMTPT, PCES, Doula Foundations PelvicPhysio, LLC Orthopedic & Pelvic Health Physical Therapist & Birth Doula Instagram: @emma_pelvichealth Subscribe to my newsletter: Click Here!
