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Health Insurance: Why We're Out-of-Network, On Purpose

healthcare insurance physical therapy Oct 06, 2022

By: Grant Norland

 

You’ve probably heard the phrase, “our healthcare system is broken.”  We made a decision before we even opened our doors to become a part of the solution, rather than a contributor to the problem.  We have been a direct-payment (or “cash-based) physical therapy practice since we started Inspired Athletx several years ago. 

What does that mean?  It means that we do not contract with health insurance companies or process insurance payments for our physical therapy services.  While some may think that’s crazy, or something that wouldn’t work as a business practice, allow me to share why it works better and why it’s a massive benefit to the people we serve.  

Ultimately, direct-pay physical therapy provides a higher quality service, yielding faster results, often times at a lower total cost to the client.  How is that possible? 

  1. Higher Quality of Care
  2. Incentivized Only By Your Outcomes
  3. You’re In Control
  4. You Can Ultimately Save Money

 


 1. Higher Quality of Care

We deliver a higher quality of care.  As a patient, when you can work 1-on-1 with your doctor of physical therapy for a full hour, the quality of care you receive is substantially higher and more effective than alternative models. 

Often, in insurance-based models, a patient will see multiple providers, many of whom are assistants or techs who do not have the level of expertise of a doctor of physical therapy.  For example, you may see a PT for 15 minutes (or sometimes not at all) and spend the remainder of your appointment doing exercises with little supervision or intentional coaching.  The cumulative effect of this makes your time spent at your physical therapy appointments less efficient for you, resulting in more appointments and longer total time spent recovering.  

Insurance-based clinics also tend to “bill for bandaids,” which is a term I use for billing patient’s insurance for applying a hot pack, ice or other modality to a patient (something they could easily do at home) and then having them sit there unsupervised while they bill your insurance $55. 

That’s a load of BS, if you ask me, and doesn’t do a whole lot for making you recover faster.  It’s certainly a waste of your time in the clinic.  We don’t do bandaid treatment, because it’s not the best thing we can offer people, and, frankly, when people are paying for a service directly, they won’t throw their card down or write a check for that (which should tell you all you need to know about the value).

 

2. Incentivizes 

“I’m going to let you in on a dirty little secret in the healthcare industry…”

Our only incentive is providing you with the best care possible.  Put another way, reimbursement rates do NOT dictate care.  I’m going to let you in on a dirty little secret in the healthcare industry and a big reason why price transparency and more direct patient/doctor payment relationships are needed.  Whether it occurs consciously or unconsciously, reimbursement rates often dictate the care you receive.  What does this mean? 

If a health insurance company pays a physical therapist $48 for spending 15 minutes working on exercises with you and $38 for that same 15 minutes if the therapist is providing manual therapy (hands on) treatment, which do you think you’re going to get?  And this happens across the board.  $10 may not seem significant, but if you’re doing 8 appointments for 45 minutes each and are presented with that option at each increment, that’s a difference of $240 in one day and over $60,000 in a year.  It’s not hard to see how that math will dictate the service you receive.  

It makes a big difference when the only thing on your PT’s mind is making you better as soon as possible.  

 

3. You are in complete control

The only conversation you need to have about your care is directly with the person providing it to you.  There are no phone calls to authorize additional visits or certain treatments.  You call all the shots because you’re the provider’s customer, not a health insurance company’s.  We don’t think the pencil-pushers at Choose Your Favorite Insurance Company should be dictating the care you receive.  

 

4. You may ultimately save money

It may be difficult, at first glance, to see how paying $175 for a one hour appointment when your insurance copay is $50 per appointment would be a financial benefit to the patient. 

First and foremost, I believe you have to consider the cost of your time.  Without even getting into the math yet, if you can get the same outcome in 3 weeks vs. 6 weeks in an insurance-based clinic, what is that 3 weeks without pain or the issue you’re dealing with worth?  That’s where this becomes more of a question of value and not just price alone, but let’s look at the total price tag also. 

If you haven’t met your deductible, your actual out-of-pocket expense will be far higher in an insurance-based clinic.  What we would charge $175 for, the full price from a clinic that typically bills insurance would be in the ballpark of $250-$300, and sometimes even higher, for lower quality, less efficient care.

In a direct-pay physical therapy model, you will receive a higher level of service, get better faster, and often spend less total money doing so.  It’s a trifecta of wins for patients! 

As a bonus, you get the peace-of-mind of knowing exactly where your money just went, directly to the person helping you, without it being first funneled through the hands of the people who are continually making healthcare less efficient and more expensive.  I hope that you’ll join us in this movement toward higher-quality healthcare and a healthier society. 

P.S. For those still wondering, yes we do provide super-bills for our clients, so if you choose to, you can still submit our services as a claim to your health insurance and seek reimbursement.  Just remember, we’re out-of-network, on purpose.

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