An out-of-network provider is one who is not contracted with any insurance company for reimbursement at a rate that they have negotiated.

What does this mean?

This means that I have a fee for service that is due at the time of treatment. I technically don’t take insurance, but there is a chance that you can still get reimbursed. Many plans have out-of-network benefits that can reimburse you a portion, if not all the money, that you pay for therapy. You can also get reimbursed if you have a Flexible Spending Account (FSA).

Your responsibility: inquire from your insurance company or benefits manager about the necessary requirements to get reimbursed with your out of network benefits

My responsibility: I will do my best to provide you with the documentation needed for you to get your money back

Why I chose to follow this model

Last year I worked as a physical therapist for a major hospital company. This year I am working for a private practice. My setting has changed but the problem continues to be the same

• Reimbursements from insurance companies are decreasing every year. This is forcing most clinics to see 3-4 patients an hour to meet previous profit margins. In this system, we as physical therapists are only able to give each patient 10-15 minutes of face-to-face time before handing you off to a tech or leaving you to perform the exercises unsupervised. I feel that this is not worth your money or your time. As a patient, you are at the utmost priority and deserve 1-on-1 attention for a full hour with your physical therapist. Being out-of-network allows me to practice that way and free from the chains of major corporations
• Insurance companies drive the way physical therapists treat. More often than not insurance companies only grant a certain number of visits. For this example, let’s say 6 visits. This is how that plan of care will typically go:
  1. Visit 1: Initial evaluation
  2. Visit 2-5: treatment sessions for around 2-3 weeks
  3. Visit 6: Re-evaluation
  4. Wait 2-3 weeks to get approved another 6 visits
  5. Rinse and repeat

There’s so much red tape and waiting when insurance companies are involved. A stranger in a cubicle who has never met you is deciding how our treatment sessions should go. Being out of network puts the therapist and the patient in full control of how their plan of care should go. Whether you need 1 visit or 20; you should have full control when your health is concerned.

If you have any questions, comments, or concerns feel free to contact me