Why Out-of-Network Pelvic Floor Therapy is a Better Value
Reimagining the Cost of Care
You may be noticing that more private practices are going out-of-network with insurances. So what does out-of-network mean and why are some practices making this shift? Being an out-of-network practice means the providers do not have a contract with insurance companies and therefore they don’t bill the insurance directly. This does not necessarily mean that you can’t use your insurance. Many providers are going this route, in order to provide a standard of care they feel patients deserve. As someone who has worked for in-network practices in the past, I know firsthand the challenges that come with insurance-based care. Let’s talk about in-network vs out-of-network and what this means for getting value for your dollar.
The Hidden Costs of In-Network Pelvic Floor Therapy
High Deductibles: Patients often have to meet a deductible before insurance covers any therapy. Over the years, most insurance companies have moved to high deductible plans, meaning patients will often have to pay thousands of dollars out of pocket before their insurance coverage even kicks in.
Example: A $2,000 deductible might mean paying out-of-pocket for therapy for the first $2,000 and after that amount, your insurance will kick in and cover a certain amount.
Delayed Billing and Surprises: Insurance companies don’t always state how much they will cover up front. They typically have the provider submit the claims for therapy provided and then reimburse at a later date. Your provider gets reimbursed a certain amount and the remaining balance is passed on to you. This means patients may receive bills weeks or months later, creating unexpected financial strain.
Example: A patient of mine told me a story of how she went to an in-network therapist years prior. She was told everything was covered because the office was in-network with her insurance. 9 months after completing therapy, she discovered she owed hundreds of dollars from seeing her therapist twice a week for several months.
Restricted Coverage: Reimbursement aside, insurance plans will often limit the number of sessions (cutting you off if your progress is too quick or not quick enough), the type of care provided, and even dictate which therapist patients can work with, potentially leading to subpar outcomes. This has caused some therapists to change their treatment plan vs doing what they feel is clinically best for the patient.
Example: Therapists can be prohibited from providing both manual therapy (hands-on treatment) and exercises within the same visit.
Example: Your insurance may restrict you from seeing both a PT and another provider, like a Physician or Chiropractor, in the same day.
Effective and Valuable Care: Due to restricted coverage and reimbursement, many in-network clinics choose to supplement quality care with fillers like 20min of ice/heat and electrical stimulation. While these modalities may feel good in the moment, they are certainly not a substitute for skilled care. Nevertheless, insurance companies are more likely to reimburse providers for this nonsense than a technique that the therapist has specifically sought out training in. This forces some great clinicians to have to make difficult decisions regarding the care they provide.
Benefits of Choosing Out-of-Network Care
Quality of Care and Service
First and foremost, you should consider who it is you’re working with and what type of care you expect to receive.
Out-of-network therapists can offer individualized care with fewer restrictions.
Sessions focus more on addressing the root causes of concerns, leading to faster progress.
Treatment is solely based on what is right for YOU and not what the clinic is “allowed” to do.
Visits are usually longer and don’t involve being passed on to a tech or aide during your care. This ensures you’re with a highly trained provider throughout your entire session.
At Restore Pelvic Health & Rehab, you can be sure that you’re seeing a therapist who has received extensive training and is used to treating a wide variety of complex pelvic health issues every day, vs a therapist who dabbles in pelvic health and treats a little bit of everything at a big box clinic.
Transparent Cost
Upfront, transparent pricing and a flat rate per visit means no surprises to budget for.
Many private practices, like ours, accept HSA/FSA payment options which can make out-of-network care more accessible.
Many patients are still able to use their insurance and get reimbursement for visits, through their out-of-network benefits. This means they don’t have to sacrifice the quality care they deserve.
Typically, you’re paying for visits on a frequency of weekly or every other week basis, vs 2-3x/week for 30min visits at an in-network clinic.
Breakdown of costs for 2 in-network visits per week:
Example: $50 copay x 2 visits/week = $400/month.
Add-on: Deductible costs before full coverage kicks in.
Total costs for frequent visits often exceed expectations.
In Summary…
Many people assume using insurance for therapy is always the cheaper option. This is not always the case and while financial cost is an important consideration these days, if it’s only factor you’re considering in deciding where to get care, you may be putting more at risk. Out-of-network care can provide better value, fewer surprises, and faster results. This is because out-of-network providers work for YOU and not the insurance companies.
What Next?
I hope this information was helpful and maybe caused you to look at symptoms you have been ignoring. If you need help finding a pelvic floor therapist in Florida, we hope that you will consider us for either in-person or virtual appointments.
In the meantime, you can get more pelvic health content sent right to you, by completing the short form below👇
