My goal in writing this is to help everyone be better informed consumers so they can make the best decisions possible for themselves! While I strongly believe in the many benefits of the out-of-network aka cash-based physical therapy model, I understand that in-network can be a better fit for some people. I truly want what is best for each person who crosses my path, and I especially want everyone to understand the financial implications of each model so there are no surprises.
So, let’s quickly address the difference between in-network and out-of-network physical therapy.
In-network: There is an agreement between your insurance and the provider stating the insurance company will pay agreed upon rates and the provider must follow the insurance company’s treatment guidelines. Because of this agreement, the insurance companies regulate the number of visits you have, when you will be discharged, and the type of treatment that is covered. The insurance company typically pays a percentage, and you pay a copay each visit.
Out-of-network: There is no agreement between the provider and your insurance company. This means that the provider is able to treat you how they see fit without restrictions from the insurance company. You pay at the time of service and there are no surprise costs after your treatment. You may be reimbursed depending on your plan and you can pay with a health savings account.
10 Reasons to go Out-of-Network (Cash Pay):
1. More 1-on-1 time with your Doctor of Physical Therapy.
You will see me for 60 minutes each visit and have my undivided attention. No techs or aids, no distractions.
2. Save time with less visits per week and less overall visits needed.
Time is valuable. That means you will need less time off work, less travel time, and fewer times you must find a babysitter. Also, no lobby room wait times! We will see you right at your appointment time.
3. Significantly higher quality of care with a VIP experience.
I can’t promise you will find this at every cash-based PT practice. But at Outshine, we intentionally create an environment that is unlike most PT practices from the start. You will talk directly with me for 15+ minutes during your free phone consult to determine if we are a good fit. Then you will have access to me via text/call, added communication points, referral programs, swag bag, etc.
4. Build a strong patient/provider relationship.
This is one of my favorite parts of what I do! I love getting to know what motivates you, learn about your families, and more. You will have my cell number and I encourage patients to reach out to me anytime they need. I will go to doctors’ appointments with you and go the extra mile anytime I can. I stay in touch with most of my former patients. Some come back on a regular basis for proactive care and others stay connected via social media or drop by to say hey.
5. Schedule accommodations.
We work with busy active adults and athletes like you. We understand that you may need certain times. That is why we offer evening and weekend availability to ensure you get the care you need.
6. Work proactively to avoid injuries and improve performance.
In-network physical therapy will only allow a certain number of visits within a year. Insurance also does not typically cover injury prevention/maintenance work and prefers to discharge you once you are functional in day-to-day activities. However, functional doesn’t help you keep your issue from returning or get you back to the higher-level activities you love.
7. Comprehensive approach.
Because we have the time, we are able to consider and discuss your sleep, hydration, diet and more to provide the quickest recovery possible.
8. Cash-based providers are oftentimes niche specific and the best in their fields.
Most cash-based or out-of-network practices specialize in a certain field. At Outshine, we specialize in strength and fitness. We blend the rehab and performance worlds to best care for active adults and athletes. We have the top-notch tools and skills to match including a full gym, blood flow restriction training, dry needling, and more.
9. Consider the cost.
You may actually spend less at an out-of-network provider, especially long-term. Consider these common scenarios:
a. You have a $3000 deductible that needs to be met before your insurance will pay any portion of the bill. Your in-network physical therapist wants to see you 2-3 times a week for 8 weeks. You will pay the full visit amount which could be anywhere from $150-400+ per visit until the $3000 is met. You might not always know this ahead of time and could get surprise bills after your care.
b. You have a high copay of $60-80 per visit. Your in-network PT wants to see you the standard 2-3x/week for 8 weeks. You will have just spent ~$1000+ to spend only 15-20 minutes with your Doctor of Physical Therapy each visit before they have to hand you off to a tech or put you on a piece of cardio equipment while they manage their other 2 patients.
c. You work 1x/week for 6-12 weeks with an out-of-network provider and spend $1000-2000. They help you get out of pain and get back to the activities that are important to you. You learn how to prevent this from happening again and how to manage your own body. You avoid unnecessary medications, injections, and surgery which saves you thousands of dollars.
PS: Your insurance may reimburse you for all or a portion of your spending (depending on your plan).
We provide you the superbill and you send off to your insurance company for reimbursement. You can call the number on your card and ask what your out of network physical therapy benefits are to learn more.
10. Invest in yourself and your health.
No one else can do it for you. Could you put a dollar amount on the things most important to you?
a. Getting to coach your son’s baseball team and throwing with him without pain.
b. Achieving a personal record on a 5k or marathon that you never thought you would be able to race in again.
c. Being able to get on and off of the ground to play with your granddaughter and lift her up without back pain.
d. Returning to mountain biking stronger than ever after a bad accident.
e. Being able to exercise without pain in order to relieve stress/manage your weight/age strong/etc.
Interested in making meaningful changes to your health and wellness? Questions?
Click here to book a free phone consult!