You may have noticed a trend in the healthcare space that more and more providers are switching to an out-of-network or cash-based model. Reimbursements from insurance companies have been on the decline making it more difficult for healthcare providers to focus on quality care. Out-of-network or cash-based practices allow providers to put the patient first. If you have ever been to Physical Therapy and felt like you were just a number or it didn't really work for you, this article is for you and you will learn why it is worth the investment! 

Out-of network PT provides a unique level of care that goes above and beyond what is typically offered by insurance-based physical therapy providers. I have been treating patients under this model for the past 17 years at CORE Physical Therapy.  I like to say we were one of the OG’s when it comes to out-of-network PT. We originally chose this model because it allows us to provide the best treatment for our patients based on individual needs instead of having to function within the limitations of doctor referrals and predetermined number of treatments provided by insurance companies. We continue to see the best and most efficient recoveries while providing patients with personalized care, enhanced treatment options, and improved outcomes. 

WHAT DOES CASH-BASED OR OUT-OF-NETWORK MEAN?

In a cash-based or out-of network treatment model, the PT enters into an agreement with the patient to provide physical therapy services. The patient pays at the time of service. In most cash-based models, the insurance company is not billed directly, but the patient is provided a detailed superbill that can be submitted to their insurance company for reimbursement. This paperwork will specify that reimbursement should be sent directly to the patient.

As a courtesy, some out-of-network PT companies will submit the claims to the patient’s insurance company for you and the patient will still get reimbursed directly from the insurance company. We provide this service at CORE Physical Therapy. 

BENEFITS OF CHOOSING AN OUT-OF-NETWORK PT PRACTICE: 

1. One-on-One quality care ALWAYS with a licensed Doctor of Physical Therapy. You will not be treated by a PTA, techs, or trainers. 

2. Direct access and increased convenience: One of the primary benefits of out-of-network PT is direct access to care. Unlike traditional PT, which often requires a referral from a physician, cash-based PT allows patients to seek treatment directly from a PT. This eliminates unnecessary delays, allowing you to receive prompt care for your pain. Many states, including Washington DC and Maryland, are Direct Access states, so we can treat you without a physician’s prescription and you should still get reimbursed. 

3. Individualized personalized care: Out-of-network PT offers personalized care that is tailored to the specific needs of each patient. Unlike traditional in-network PT, which often involves working with multiple patients at the same time, out-of-network PT always provides patients with one-on-one attention, allowing for a more customized treatment plan.

4. More freedom to address multiple issues: In an insurance based model, insurance companies will only pay for treatment to 1 body part at a time. For example, if you are seeing a PT for back pain and then one day you come in with knee pain, they can not treat your knee that day but instead you would need to schedule a separate appointment for that new body part on another day. Whereas, in a cash based or out of network clinic, we can treat any body part on any day without fearing that insurance will deny our claims. You get better faster because we can address all of your needs in a holistic and efficient manner.

5. Greater continuity of care: In the traditional PT model, patients may be shuffled between multiple therapists due to scheduling constraints or availability. In cash-based PT, patients typically work consistently with the same therapist throughout their rehabilitation journey. This continuity of care allows therapists to develop a comprehensive understanding of the patient's progress, adjust treatment plans accordingly, and build a strong rapport with the patient.

6. Faster recovery: Out-of-network PT has been shown to help patients achieve faster recovery times than in-network physical therapy. This is because the personalized attention and individualized treatment plans can address the specific needs of each patient, leading to more efficient and effective rehabilitation.

7. More Direct Communication with Therapist: Cash-based physical therapy offers more direct communication with the therapist, allowing patients to have more frequent contact with their PT. All of my patients have my email and they know they can email me at any time and that I always get back to them in a timely manner. This can lead to better outcomes, as patients can receive timely feedback, advice, and support throughout their rehab process. 

8. Focus on Wellness and Prevention: Out-of-network PT clinics often emphasize overall wellness and injury prevention, not just treatment. This can include education on nutrition, stress management, and other lifestyle factors that can impact a patient's overall health and well-being. These wellness services are incredibly important. Instead of just treating a specific injury, we also help patients get stronger and more mobile to prevent future injuries.

9. No unexpected bills will show up in the mail months after your care has ended. And, did you know that you can actually save money with cash based physical therapy? Yes, you read that right. While traditional PT clinics will see you 3x a week while seeing patients at the same time as you, we only see you 1-2x/week or sometimes even less.  You tend to need less visits, and in the long run may end up spending less with us than a traditional PT practice when you consider your deductible, co-pay, and extra visits needed. 

WILL I GET REIMBURSED FOR OUT-OF-NETWORK PT SERVICES?

Yes. Most insurance companies, with the exception of Medicare, Medicaid and HMOs, will provide payment for services received "out-of-network". Going out of network means that you can choose to see a PT who is not a participating provider with your insurance company. Many patients choose to receive services out-of-network in order to see the PT of their choice. 

I became a PT because I wanted the best possible outcomes for my patient while putting them first. While out-of-network physical therapy may not be fully covered by insurance, the benefits far outweigh the costs. By providing individualized attention, extended treatment sessions, faster recovery times, more direct communication with the therapist, and a focus on overall wellness, out-of-network physical therapy goes beyond the limitations of insurance coverage, ensuring that patients receive comprehensive and effective treatment.