What Is the Difference Between an In Network and Out of Network Physical Therapy Clinic?




Hey guys, it’s Stephen at CORE Therapy and Pilates… today I want to go over a topic about in network or what I call contracted or insurance contracted facilities versus non contracted facilities or out-of-network, which is what we are here at CORE… I saw a video just the other day from a friend of mine down the street who is a physical therapist, Jarod, who got me involved in the cash based PT world and this is a great post that needs to be put out. I think it’s fantastic for all potential physical therapy clients to hear this. So what happens is we’re at a point now where deductibles are higher than ever, co-pays and coinsurances are higher than ever and January, just a few days away, we’re gonna see those deductibles turn over. So people who are in network and have a high deductible, with say two, three, four or five thousand dollars, which is very common today, they’ll have to pay out of pocket to see a physical therapist, in network or out of network, until that deductibles met.

So the question becomes what’s the difference in an network clinic quality of care? Well when you come to a place like CORE to see me or my physical therapist, Allyson, it’s one on one care with a physical therapist for the whole time, we don’t use aides or assistants. It’s very focused on the patient, client, it’s not what the insurance dictates and thinks we should be doing. When you go to the insurance based clinic it’s really based on what your insurance says and demands and dictates. It’s a very different thing… but what I want to present today there are a couple questions that you should ask if you’re a potential physical therapy client trying to determine the cost and what’s the better value for going to an in-network place or an out of network place. I’m going to read off a couple questions that I want you to ask your insurance providers:

1: Until I meet my deductible what can I expect to pay for each session of physical therapy at an in network PT clinic? They may only give you percentages like 80 or 90 percent but the typical fee that private practices will be charging will be $250 and above and if you go in to a hospital facility, they will be charging $500 or above (per session)…

the next question,

2: What can I expect in reimbursement or application to my deductible if I get physical therapy at an out-of-network provider and send in self claims? Just so you know, if you do get in touch with an insurance company they will try to persuade you to go in network and not out of network… that’s just how it is, it keeps the contracts and whatnot, keeps them in a little more control, I’ll just leave it that way.

Now what are the questions that I would want you to ask you the in-network facilities. So you’ve called me, we’ve gone over what we can do, what do you ask them when you call the in network facilities, what do you ask them?…

1: On average how many patients per hour do your providers treat? Many times the physical therapists they’ve seen two, three, four or five patients an hour, sometimes more.

2: Are only physical therapists providing the care or do you use assistants, aides or techs?

3: How much one-on-one time will I get with the physical therapist in each session?

4: On average how many times per week do patients come in for treatment?

With knowing this information and then coming in to see me for my free discovery session, we can really look at what’s going on, what’s the best solution for you, so you can make a better decision about your health moving forward with all the information and knowledge.

This is just something to chew on. I think a lot of people think because I don’t take insurance that it’s going to be a lot more expensive than going to the place that does take insurance. I typically see people once a week and get them better very quickly versus going to an insurance based facility and going in two or three times a week and doing the stuff you can do at home. I’ll teach you to do your homework at home instead of having some aide that makes 10 bucks an hour watching you do it. So a little difference in the quality of care, a little difference in the speed of getting people in and all those things.

So that’s it for today I just wanted to go over this in network and out of network… I think a lot of people get caught up in that and don’t truly understand the deductible scenarios, the co-insurances, the copay.

So I hope this helps you, if have any questions just leave them in the comments below (on youtube)…

If you have had a bad experience at the doctor owned clinic, or the hospital or corporate clinic? If so, we are very different in every way…

Ever tell your Physical Therapist that your low back is bothering you as well as that shoulder injury, only to be told, I can only work on your shoulder what you were referred in for…

All of these are the reasons I am non contracted, out of network with all providers…

Stephen Dunn

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