Understanding a cash-based out of network clinic

Why are we out of network with private insurance?

As providers we need a space where we are able to deliver high quality care, and not be forced to dilute our treatment in order to add the payroll that is necessary to get paid by insurance companies.  We have worked in that environment for too long and refuse to dilute what Physical Therapy should be.

Are we the cheapest option in town?

Not always, but sometimes.  See chart below to further explain the bigger picture of dollars spent.  

As a consumer of healthcare services, you need to fully understand how to best utilize your insurance benefits in order to always find the highest quality, most effective choice for your individual needs.

Why should you consider going out of network?

Going out of network allows us to have more one-on-one time with our patients, which results in decreasing the frequency of care required, and results in more effective and efficient outcomes.  Many traditional Physical Therapy clinics will suggest that ALL new patients attend 3x/ week for 4-6 weeks, with a patient payment associated with each visit.  Our philosophy is to treat as infrequently as possible, because the power to heal needs to be shared between the patient and the practitioner.  Part of the treatment plan involves techniques to decrease pain and improve function that only the practitioner can perform, but then the patient needs to use the new motion and participate in all ergonomic changes, lifestyle changes, and home exercise program specifically created for them.  This increases the independence of the patient and decreases the reliance on high frequency visits.

In the following circumstances, going to an out of network physical therapy clinic can actually be the same cost or cheaper than going in network!

• If you have a high deductible plan and will be paying cash towards your deductible, our rates and bundle packages are often lower than in-network rates. Some deductibles even cross accumulate in and out of network!
• If you are using funds from your health savings account or flex savings account, our decreased frequency of visits is less likely to exhaust your funding!
• If you have met your out-of-pocket maximum for the year and your insurance is paying 100% of your healthcare bill, in and out of network clinics may be covered at the exact same rate.
• Example Costs for the same diagnosis, but the out of network plan is specifically designed to address short term goals, as well as, ensure long term ability to maintain improved motion/ decreased pain.

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