In the world of healthcare, the decision whether to accept insurance or operate on an out-of-network basis is a crucial one for practitioners. As a physical therapist, my choice to remain out-of-network might seem counterintuitive to some, but it’s a decision grounded in providing the best care possible to my clients. In this blog post, I'll delve into the reasons behind this choice.
Many people ask me as a private provider if I accept insurance and the answer can be a bit complicated. I do not take insurance and probably will not for the foreseeable future. I am now able to offer super bills though. A super bill includes the codes that large hospitals systems use to bill insurance. With a superbill, you can yourself submit it to insurance and sometimes get reimbursed directly or at least have my services count towards your out of network benefits.
Below are some of the reasons why self pay physical therapy can be a great option.
1. Flexibility in Treatment Approaches:
One significant advantage of being out-of-network is the freedom it affords me in crafting personalized treatment plans for my clients. Insurance companies often dictate treatment protocols and limit the types and frequency of services covered. By not being bound by insurance regulations, I can tailor treatments based on individual needs rather than predetermined guidelines. This flexibility allows for more innovative and effective therapeutic approaches that prioritize the client's well-being above all else.
For example, many times trigger point dry needling or even the use of cupping is not covered. If you go to a clinic, you will have to pay for that in addition to whatever your copay or co-insurance etc is. All treatments with Logan include whatever is needed. No surprises, no hidden fees. 1 session price. Complete price transparency. Even the wording used in documentation and how someone bills and codes something working in a large system can vary. Logan uses cupping tools for scar mobilization and C-section recovery but many insurances in State of Minnesota, if they see the words cupping, will not cover it. Self pay is a great option to get the care you want and need without the 3rd party hassle.
2. Focus on Quality over Quantity:
Insurance reimbursement models often incentivize volume over quality of care. Physical therapists who accept insurance may find themselves pressured to see a higher volume of patients to meet financial targets set by insurance companies. Unfortunately, this can sometimes compromise the quality of care provided, as therapists may not have sufficient time to dedicate to each client. By operating out-of-network, I can prioritize quality over quantity, devoting ample time and attention to each individual's treatment journey.
Insurance companies have started reimbursing less money for physical therapy services. This means clinics need to force physical therapist to see more patients to make the same amount of money. They also have been shortening sessions so PTs have to see more patients or pressure providers to bill many units to insurance. Many people have started pursuing self pay options in order to retain that quality care.
3. Transparency in Pricing:
One of the most significant challenges of navigating the insurance landscape is the opacity surrounding pricing and coverage. Deductibles, copayments, coinsurances, and coverage limitations can be confusing and frustrating for clients seeking care. As an out-of-network provider, I strive to maintain transparency in pricing, offering clear and upfront information about the cost of services. This transparency empowers clients to make informed decisions about their healthcare without the confusion often associated with insurance billing. Many times depending on your deductible, and co-insurance etc, self pay can actually save you money in the long run. Some people may only need a few sessions of PT but depending on your insurance, that could see be over 500$ where most self pay PTs are in the 150-300$ range per session. Logan also offers stand alone services you can pay for like dry needling and soft tissue mobilization/massage so you can get what you need without the hassle.
4. Enhanced Therapist-Client Relationship:
Building a strong therapist-client relationship is paramount to successful rehabilitation outcomes. When clients are not restricted by insurance networks, they have the freedom to choose the therapist they feel most comfortable with, rather than being limited to a list of in-network providers. This fosters a deeper level of trust and collaboration between therapist and client, ultimately leading to better treatment outcomes. Logan likes to talk! She likes to get to know her clients and build that life long relationship. She will always be there for you. Logan also believes in the continuity of care. Seeing one provider is better just for everyone. No more seeing a million different therapists each time you go in.
5. Investment in Continuing Education:
Staying at the forefront of advancements in physical therapy requires ongoing education and professional development. However, insurance reimbursement rates may not always adequately compensate therapists for the time and resources required to pursue continuing education opportunities. By operating out-of-network, I can invest in advanced training and specialized certifications that enhance my skills and allow me to offer cutting-edge treatments to my clients. Logan is currently taking a new pelivc floor course!
In conclusion, while the decision to remain out-of-network as a physical therapist may seem unconventional, it ultimately stems from a commitment to providing exceptional care tailored to the individual needs of each client. By prioritizing flexibility, quality, transparency, and the therapist-client relationship, I believe I can offer a higher standard of care that is truly worth the investment.
Have questions? Reach out!
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