Have you ever spent precious time researching a healthcare provider, finding one you’re excited to work with, and THEN finding out they’re not ‘in-network’ with your insurance? It feels like you’re back to square one, looking for a provider that your insurance works with…but does it have to be like that? In this blog post, we’re talking about what it looks like to choose providers that aren’t necessarily covered by insurance - and how it can benefit you. 

Benefits of Choosing a PT with Your Gut…Not Your Insurance Card

1. The provider isn’t worried about reimbursement when deciding what treatment you need. Having up front billing at a flat rate ensures that your care is more customized to exactly what you need to reach your goals.

2. Because your provider can focus solely on your care, you are more likely to get better, quicker and stay better for longer. You get more bang for your buck during the time you have with your PT because they aren’t using passive treatments like biofeedback, estim, or ice/heat that don’t help you as much as other active treatments.  

3. Your PT is able to look at you as a whole person, and treats you like one. If a new problem arises while you’re being seen for something unrelated, your PT can help without fear of insurance denying payment or future sessions. 

Insurance Limitations

Billing

Let’s be honest, when it comes to choosing a healthcare provider, most people gravitate towards in-network providers because they believe it will be a cheaper price. This isn’t always the case and very much depends on what kind of insurance plan you have. High deductible plans, FSA or HSA, and various versions of ‘Out of Network’ benefits are enough to send your head spinning when trying to figure out what kind of coverage you might have if you did choose a provider out of network. 

What most people don’t consider when looking at the price is if they’re getting their money’s worth during their session. A common issue we see with billing insurance for treatment is that the patient ends up getting treatment not based on what will help them the most-but what will provide the highest reimbursement to the clinic. Meaning your treatment might help, but not be exactly what you need to reach your goals. Clinics will also use more passive treatments, such as ice, heat, or biofeedback, because they don’t require the PT’s full attention but still get reimbursed at a reasonable rate. 

For example, the treatment type that gets reimbursed at the lowest average price is Manual Therapy--this leads to providers spending less time on the hands-on care and more on exercises, education, and other interventions. Not that each piece of treatment doesn’t have its benefits, however, the hands-on manual release to injured and painful tissues is a MAJOR step to fully recovering. When it's not given the time and energy it deserves, it can take longer to get pain management, reach goals, and less long lasting recovery. 

Quality of Care

Let me tell you a story about a patient of mine who was coming for treatment to help her with Diastasis Recti. As we made progress on her core strength and abdominal separation, she brought up that she’s recently started having pain with intercourse and wasn’t sure why. Now if we were in a classic insurance model clinic, I would have had to send her back to her OB or PCP to obtain a different referral for her pelvic floor concerns. Luckily, because of how we work with insurance- we were able to assess and start treating pelvic floor dysfunction that day, allowing her to have pain-free sex again after a few sessions!!

This type of thing happens more than you would think, and more often than not leads to symptoms worsening while waiting for referrals and insurance approvals. These restrictions not only impact people’s quality of life, but can also lead to people not seeking help at all because of all the hoops they have to jump through!

Another difference we see between the two models is how many sessions the patient is given. When insurance is dictating how long the patient can receive care, it doesn’t always line up with their goals. This leads to people being discharged before their issues are fully resolved, increasing the chances that they’ll have a flare up of symptoms a few months down the road. With the out-of-network model, the PT and the patient work together to build a plan that will help them reach their goals AND keep the issue from coming back after they’re discharged. 

To Sum It Up..

Are you tired of following all the insurance rules just to get surprise bills, less than ideal care, and still having the symptoms you came in with? That’s how you know it’s time to trust your gut instead of your insurance when choosing a provider. Trusting and liking your provider is majorly important to get good outcomes with Physical Therapy, so you should be able to pick and choose who is on your team! If you’re ready to get started with one of our Women’s Health Specialists, call or email today to take the first step!