“So, do you take insurance?”
This is one of the most common questions that a new patient asks me. My answer is no, I am not contracted by any insurance companies. However, if your plan has out-of-network benefits, your treatment may have the potential to be reimbursed.
Why is this such a common question?
That is an easy answer – because most insurance companies pay for a portion of physical therapy treatment.
What do you know about insurance-based PT?
Having been a therapist for 7 years, I have provided treatment to a wide variety of patient populations within clinics under an insurance-based model. Within this model, there are many rules and regulations that therapists must follow, that are dictated by what the insurance companies will reimburse the clinic. For example, in many cases treatment was more about “getting the patient seen [and billed]”, vs “this patient needs to be seen to continue to progress their treatment plan so they can get back to running”. I continuously felt as though I was just going through the motions and checking the boxes during treatment sessions. I was always taking time away from patient care to do tedious documentation, writing notes to prove to the 3rd-party payers that the patient needed to continue therapy.
Have you ever called a PT clinic for an appointment?
Patient calls: “Hello, my doctor recommended PT, because I hurt my knee running. I have been dealing with this pain for a few months now and I am really starting to worry that it is something that will never go away.”
Receptionist: “Okay, what type of insurance do you have and what is your name and date of birth?”
Wait a minute… what if the person who answered your call asked you about your knee pain? Asked you how you hurt it? What type of training do you do? What are your symptoms like? And told you how they cold help you with the pain.. showing a bit of empathy vs immediately asking what type of insurance you have. They could answer your questions right away and decrease your fear and anxiety about your condition.
Insurance-based models unfortunately have been built by the framework of the rules and regulations of insurance companies. Treatments are dictated by what the insurance companies’ reimbursement rates are. As the therapists working at these offices, we are forced to look at patients as numbers. Now, don’t get me wrong, I understand that it is a business, however, having autonomy as a caring therapist, I would like to primarily see the patient as a “client” and a “person” before I see the dollar sign attached.
Here are some of the benefits of seeing a therapist who is
an out-of-network provider:
- Every treatment session is one-on-one. This is a huge benefit to a patient! Many insurance-based clinics have therapists working with multiple patients at a time and sometimes seen by multiple PT’s throughout their course of care. I want to be able to devote all my attention to one patient at a time. This is where quality care comes into play.
- Multiple areas of the body can be addressed at one time. This is another benefit. I can not tell you how many times I was forced to address only one area of the body within a course of treatment sessions. This has a lot to do with insurance rules. Most insurance companies will not pay for multiple diagnoses being treated at one time. Additionally, with a typical 15 to 30-minute PT follow-up session, multiple areas of the body are not able to be thoroughly addressed. In the out-of-network model, 60-minute treatment sessions are the norm and can successfully address multiple conditions.
- Direct access. The law in Massachusetts allows PTs who hold a Doctorate-level degree to see patients without a doctors’ prescription. Why is this a benefit? You are allowed to call your local out-of-network PT and get an appointment FAST. You can skip the steps of making an appointment with your primary care or orthopedic doctor.
- Extended length of care. What does this mean? I have been in countless situations where patients are cut off from their insurance coverage because PT benefits were exhausted. Due to the fact that insurance rules do not regulate the length of care in an out-of-network clinic, patients can continue treatment until they feel comfortable returning to activities, sport, etc. This also leaves room for maintenance care, a type of treatment that is never covered by insurance.
Out-of-network providers are striving to bring the autonomous practice into physical therapy. I became a PT because I care about helping people, I care about making a difference in people’s lives. For a long time, I was lost in the hustle of the insurance-based model. Sure, I was going to work every day and making a difference and impacting people’s lives, but treatment length and content was dictated by a higher power, vs being driven by the true needs of the patient. I have become an out-of-network provider to be a part of the shift in healthcare and promote wellness, restorative, and preventative care.
If you have interest in learning more about my practice, please visit www.infinitepotentialptw.com.