So many people have questions when it comes to insurance and out-of-network care. We are here today to give you an in-depth understanding of what it means to be out-of-network and how you can be in the driver’s seat when choosing a provider that will meet your health care needs, regardless if they are “in” or “out-of-network.”
First let’s get to the basic definitions of “in-network.” In-network simply means that the insurance company has a contracted “pre-negotiated” rate with that provider or company for the services it provides. When you have an “in-network” therapist, it does not mean that your visits are covered, it means they have been pre-negotiated. You will typically have a copay (for Physical Therapists, this is considered a specialty copay) which often times are higher than the standard copay per visit. In addition, you could also be back billed on services that are not covered by your insurance. Just a side note, this happens A LOT in an in-network clinic, which leads to confusion by all parties, especially patients who assumed that if a clinic was in network, then all services are covered.
At Prosper Physical Therapy, our ultimate goal is not only to give unparalleled treatment and guidance to our patients, but also to provide complete transparency in cost and reimbursement. We want patients to know the exact cost upfront and to NEVER receive a back bill for any services we deem medically necessary to promote healing and function. Therefore, we are proud to be “out-of-network.” Our costs are upfront, but we always provide a “superbill” to our patients after each visit that has all of the coding present that they can submit to their insurance for potential reimbursement depending on their out of network PT benefits. Out-of-network does not mean that your insurance will not pay anything towards your physical therapy cost with that provider, it means that we do not have a contract agreement with them. We ultimately did this to put the patient in the driver’s seat for their health care.
The decision to be out of network enables us to give you the best standard of care possible. In a traditional in-network clinic, your insurance is king when it comes to major decisions. Many times, the reason why therapy can be unsuccessful or not provide long-term results are because of the restrictions imposed by insurance. We have patients sent to us regularly from in-network providers because their hands become tied due to Medicare and insurance regulations. What a blessing it’s been to be that loophole so the patient can receive care that is not dictated by an insurance company!
To best serve our patients, we only offer one-on-one sessions with an expert physical therapist. No exceptions. You need to be under the watchful eye of a trained professional, not an aide. The plan of care is created at the first visit, and evolves with each session to ultimately reach the patients’ goals. We look at the entire body, not just individual body parts and focus on improving dysfunctional movement patterns or habits that have created a break down in the body. In fact, we have had patients’ joke with us on our assessments, saying, “Okay, I know the pain is in my elbow, and you are going to tell me that it’s definitely coming from my knee.” This is a joke, but patients are often shocked at the root cause of their pain being far away from the pain site. This is why it’s critical to be in the driver’s seat for who you choose to render your physical therapy services. Our ultimate goal, is getting to the root cause, not just the symptoms.
At Prosper, we strive for long-term and lasting changes and we will continue to serve our community with the best possible care.
- Dr. Amanda Worley PT, DPT, CMTPT
- Dr. Christian Bechara PT, DPT, CMTPT
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