What Does it Mean to Go Out of Network?

In network vs out of network is a dilemma for many. Going in net work, means your provider signed up to “accept” that insurance.  The insurance ompany will then be allowed to dictate how many visits you are allowed to receive; no matter if you are fully better or not.   Going out of network means you will be receiving medical care from a provider that is outside of your insurance network. Most of the time, like with us, there is a flat fee for services, and most of the time, it is less than what the bill is for an in network provider.  This allows me to decide what care is in the best interest for each individual patient; I do not have to jump through hoops to get a service paid for if they don’t allow it.  By the way, I spent years supvervising employee’s in the  Benefit Verification department do just this, and yes, it took an entire department to get this done for patients.  You may want to call your provider, or per your request, we will call your provider to verify your out of network benefits. We will let you know the approximate cost of each session and how much your insurance should reimburse you for these services. We will provide you with detailed invoices to submit to your insurance company for possible reimbursement or application to to your out of network benefits.   These invoices are provided per visit, weekly, monthly, or at the conclusion of your Physical Therapy;  let us know your preference. We are committed to explaining your benefits to you to the best of our ability; it is ultimately your responsibility to know and understand your insurance policy details. 

Choose a provider you like and trust, not just one that is conveniently in your network.  You can always switch if it is not a good fit.

Why Do We Not Participate In-Network?

In network reimbursement rates are too low for us to see just one patient at a time. Our therapists are not required to meet productivity standards such as those at other larger clinics due to contractual agreements with insurance companies. We opt not to contract with insurance companies; therefore, our out of network status allows for a 1:1 or 1:2 therapist-to-patient ratio at all times. Our 1:1 or 1:2 therapist-to-patient ratio allows for improved results as their focus and attention is not divided among 4 or more patients at a time which is often the case when you go in network and provider as agreed to accept your insurance which involves accepting a fee schedule for all the different services the insurance company will reimburse.   By the way again, I spent years supervising these therapist’s, and guess what/  they weren’t too happy beubg asked to focus on productivity standards vs quality of care and outcomes which, of course, improve when treating only one to max two patients within an hour.

Health Savings Account (HSA) or Flexible Spending Account

You are more than welcome to use your HSA or Flex Spending Account for the services we provide to you. We will provide invoices for the services you receive; you can have them to keep on file for your medical records.

In-Network vs. Out-Of-Network

Cost Comparison between In-Network versus Out-of-Network Physical Therapy

 

In-Network Out-of-Network
1-on-1 Treatment Time with Your Physical Therapist: 15 minutes 60 minutes
Cost per treatment session: $50 co-pay* $150*
Cost per minute: $3.33 per minute $2.50 per minute

We are available to answer your questions and schedule your first appointment. As a courtesy, we will call your insurance company to verify if you have out of network coverage. If out of network coverage is available to you, we will also confirm the details of the coverage available. Our concierge services include assisting you with the arduous insurance process.

*example of an out-of-network provider charge in the Houston area. Please call to discuss out-of-network charges appropriate for your diagnosis.

Health Savings Account (HSA) or Flexible Spending Account You are more than welcome to use your HSA or Flex Spending Account for the services we provide to you. We will provide invoices for the services you receive; you can have them to keep on file for your medical records.

Insurance Reimbursement

While receiving care from a *participating Physical Therapist may minimize your financial responsibility, there may be good reasons to see a Physical Therapist who does not participate with your insurance plan. If you need a Physical Therapist that has special skills you are seeking, or if the location or other aspects of the care or facility meet your needs, going out-of-network may be a good choice for you.

We bill for only the services we feel you need to meet your goals; thus keeping your billed services below market average.

We provide invoices for services received, as a courtesy, for you to submit to your insurance company for potential out-of-network reimbursement. While there is no guarantee of reimbursement for services received out-of-network, most insurance companies do reimburse a portion of the total amount billed. Please keep in mind, it will be your insurance’s position to encourage you to go in network.

*in network with insurance plan

Health Savings Account (HSA) or Flexible Spending Account

You are more than welcome to use your HSA or Flex Spending Account for the services we provide to you. We will provide invoices for the services you receive; you can have them to keep on file for your medical records.

Supplement Your In-Network PT with Our Pilates Classes!

Pilates is a great way to supplement your Physical Therapy, be it In-Network or Out-of-Network.  AATB Pilates, our Pilates studio, offers a class to fit your rehab and budget needs 5 days a week.  Pilates improves your range of motion, breathing while exercising, flexibility, strength, balance, precision, muscle integration and your over all mood!  Our Physical Therapy practice incorporates Pilates as a part of our rehab approach and most all our patients opt to continue Pilates classes upon discharge.  Come join us!

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