In Versus Out of Network Insurance - What Does This Mean For You?
“Do you take my insurance?”
Ahhhh, the first question that every person should ask when seeking care. And rightfully so! We all pay into insurance plans, so we expect that coverage to come through when we need it! So, if the provider you are asking says “no”, you may certainly think twice before seeing that provider.
Health insurance reimbursements are very confusing to understand. Vitality Wellness has an entire billing team dedicated to this. When a patient comes in to see a physical therapist, the therapist will bill certain codes to the insurance company. The insurance company, however, gets to decide how much they want to reimburse…
How does this affect you?
As profit margins have declined, many physical therapy businesses have changed how their clinicians treat patients in order to stay afloat. PTs are asked to treat more patients - sometimes more than 20 a day (and no, they definitely are not getting paid more to do so). Treatments can include more passive modalities such as heat/ice and e-stim, instead of direct care from their therapist. These passive modalities have long been proven ineffective. Honestly, you should run for the hills if that’s all your PT gives you.
Your Physical Therapist could be the best in the world, but if insurance refuses to pay adequately, their hands are tied. And you, the patient, are worse off; you get less time with your PT and poorly designed treatment plans.
By only accepting out of network insurance or cash payment, healthcare providers are able to control the quality of treatment that they provide and the amount of time they spend with their patients.
As an out of network and cash based practice, I spend up to an hour with each patient. That means more time to develop a clear clinical picture of every single one of you, and more time to develop the relationship required to heal from your injuries, and more!
When you are investigating a potential provider, it is worth the energy to examine out of network practices to compare what you’re getting from each. Additionally, ask your friends and family for referrals, and don’t be scared to call your potential provider and ask questions.
