In-Network Versus Out-Of-Network
Is It Worth Going Out-Of-Network?
Deciding to go in or out-of-network for your healthcare needs is a personal decision based on what you value.
In this blog, we hope to provide you with enough information to make that important decision for yourself.
We discuss what exactly going out-of-network means and what you may experience with a typical in-network PT practice.
What Does Out-Of-Network Mean?
An out-of-network provider is not under contract with your insurance provider.
These contracts can place limitations on your care by only providing services that your insurance will pay for.
They can dictate how many visits you’re given, how much they pay for a visit, and how many injuries you can get treatment for at a time.
Fundamentally, when a practice bills a patient through their insurance, the 3rd party payor becomes the 'customer' rather than the patient.
This means that the contracted clinic must now abide by the rules of the insurance company even if it means delivering low-quality treatments.
What is The Typical In-network PT Experience?
While getting PT from an in-network provider may sound appealing at first glance, the typical experience is far from it.
The restrictions that in-network practices have often lead to:
Minimal one-on-one time with your provider due to multiple patients booked at the same time.
Exercises supervised by unlicensed techs
Unclear expectations of your injury and what the roadmap to recovery looks like
Lack of individualized care and getting the same exercises as everyone else.
Getting exercise instructions shouted at you from across the clinic by your PT.
Being scheduled 3x/week with a co-pay for each visit regardless of your individual needs.
Now, all of a sudden, your seemingly affordable co-pay adds up with no results to show for leading you back to square one...
Out-of-network providers can spend every minute of your session with you to make sure time is well spent.
The Cost
Going out-of-network may cost less than you think. Take a look at the Illustration below:
Now after seeing the direct financial cost of seeing someone in-network versus out-of-network, let's discuss the time cost.
Attending physical therapy 3x/week, when only 1-2 high-quality visits are needed, is extra time spent commuting, receiving a small portion of your PT's attention, and doing the same unsupervised program each session.
We all know time is invaluable which is why we provide strict one-on-one services to deliver efficient care and get you better faster. Also with being a mobile clinic, we save you time and money on commuting, child care services, and parking by bringing the clinic to you.
At Elevate, we choose to remain out-of-network for all commercial payors since we believe putting the patient first is our top priority. We refuse to allow insurance companies to influence our care by deciding how many visits are allowed and what services are covered.
The good news is that most insurance plans have out-of-network benefits and you can submit claims for any possible reimbursement from your insurance company. This way you remain in control of your health, while still utilizing the insurance plan that you have.
If you have out-of-network benefits, we are happy to provide you with a superbill for any potential reimbursement.
If you are unsure whether or not you have out-of-network benefits, please get in touch and our team will do their best to verify your coverage.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
