By “Out-of-network” physical therapy providers are not part of the insurance company’s network. Note that the provider, the insurance company, does not have a contract with the provider. Concierge In-Home Physical Therapy Providers don’t have to follow the in-network billing rules set by the insurance company for a patient they treat when they are out of network. Fees tend to be higher for care outside of the network. Some plans, like HMOs, don’t cover care outside of the network unless it’s an emergency.
Most physical therapists will be both in-network and out-of-network at some point. Both types of billing have their pros and cons. It’s important for providers to know their status with the patient’s insurance and how to bill.
Out-of-Network Physical Therapy is covered by most, if not all, insurance plans. In this blog, I’ll tell you why you might want to go to a cash-pay therapist instead of a therapy clinic your insurance company sends you to. This is also why the field of Out-of-Network Physical Therapy has moved backward. We all know at least one person who has been to Out-of-Network Physical Therapy but is still in pain and can’t move around as much as they would like.
Too many Sessions or not enough
You might think that seeing a therapist three times a week for eight weeks would be enough time to get better and get back on your feet. Quality, on the other hand, is always better than quantity. Not always is it the therapist who makes the difference. Most of the time, the problem is with the clinic itself. A lot of clinics with big names are just insurance mills. So they can make the most of the hour. They get you in and out quickly. In these kinds of clinics, one therapist might have three clients simultaneously. They might be doing exercises with one, putting a heating pad on another, and watching the third on E-stem. You don’t have to be an expert to know that if you focus on one thing, you are efficient, but if you focus on many things, you have to split that efficiency. So, the level of care gets worse.
On the other end of the spectrum, some clients need that 3 times a week but may only get it 2 times a week and half the time. This is often because of the type of insurance you have or because your policy only covers a certain amount. Both things make the patient feel wrong about Concierge In-Home Physical Therapy because it doesn’t help them get better.
Specific Treatment Specific Regions
In our healthcare system, diagnosis and treatment are based on the symptoms and the part of the body that the symptoms point to. This problem is that it never finds out why these symptoms are happening. In the insurance-based Out-of-Network Out-of-Network Physical Therapy model, a PT can only treat your knee if you say it hurts. It doesn’t matter if your knee pain comes from your foot or a weak spot in your hip. Most of the time, therapists can only do this and still get paid. Since there aren’t many places to treat, there aren’t many kinds of treatments either. Depending on the insurance company, all a patient will get for treatment is Ice, E-stem, and a few exercises to help them get better.
Why You Should Think About Cash Pay
Insurance Reimbursement. Suppose a cash-pay therapist has the right software for SOAP notes and documentation and knows how insurance companies and the system work. They may be able to send in a bill to get paid back. The difference is that the patient waits to get paid instead of the clinic. It’s great that you’re getting some of your money back, but it’s even better that your therapist isn’t looking at the time or how it’s being split between other clients.
Less time and fewer days to get better. Time is important; for most adults who work, taking an hour off a day or two or three times a week is a lot. Since a cash-pay therapist is not limited by time, treatment and recovery can be made in half the time. What could have taken three days a week might only take one. What usually takes 8 weeks can be done in just 4 weeks. This depends greatly on the therapist and treatment, but the chance of getting better is very high.
Most cash pay models have the therapist focus on the patient in front of them. You don’t have to wait for your turn with other people, and you don’t have to stick to treatments that your insurance company will pay for. Some therapists have the expertise and can use specific modalities and therapies to help their patients reach their goals.
Conclusion
More and more clinics are moving toward a cash-pay model for Out-of-Network Physical Therapy. Putting the focus back on the patient and not on how much their insurance covers has helped patients get better and improve their quality of life. In Tampa, Florida, there is a place called Dynamic Fitness and Rehabilitation. Out-of-Network Physical Therapy is our partner, and it helps us with every step of the recovery process. Its goal is to help the person feel better from the inside out. Out-of-Network Physical Therapy workers work with each person to find the cause of their pain and limitations and work with their budget and schedule to help them reach their goals.
