Imagine this: You’ve just been in a serious accident, one that left your legs broken, internal injuries, and you confined to a hospital bed for weeks. The bones heal, but since you’ve been bedridden, you need to learn how to walk again, to trust your balance and your strength. Your insurance covers your in-patient physical therapy — to a point.
While the level of care provided to you in the hospital has been excellent, your insurance wants to either send you home with at-home therapy, or to an in-patient rehabilitation hospital. That care will probably be very good. But just as you’ve taken your first steps in months, the therapy ends because you’ve reached the limit of what your insurance covers. You can try to get approval for more therapy, but since your treatment has been halted, you lose your gains while you wait for the approval. Why is that? Because your insurance company’s first concern is profit. Your physical therapist’s first concern is you, the patient.
Intown Physical Therapy believes continuing to participate with insurance companies and remaining in-network would mean the patients don’t come first. Unobstructed by an insurance company’s rules about treatment plans and length of sessions, therapists can work one-on-one with patients and develop individual goals. An insurance company shouldn’t determine when you’re alright, that you would do better in a group session, that instead of a 30-minute session, you can alleviate your pain in just 15 minutes.
If the patient and therapist think trigger point dry needling could be effective, the patient can undergo a dry needling treatment. By the way, most insurance companies don’t cover dry needling, even though the treatment has been around for years, long enough to have therapists (like the ones at Intown) skilled at it. Basically, your insurance can determine your treatment plan, not just length of treatment, but the type of treatments provided.
So, if dealing with insurance means a provider is “in-network,” does that mean not working with them means the provider is “out-of-network?” Yes. So … what’s the difference, other than the name?
In-Network
Providers offer services at a lower cost to insurers. This seems like a win-win for the patient and the insurance company. But it comes with a caveat: the insurance company determines the type care and its treatment length. To the provider, it means they see reduced rates, which could mean having to double- or triple-book patients to keep the business going.
Insurance companies determine when a patient is better — without seeing them and without witnessing their progress. They can also deny more treatment at their discretion, regardless of any goal the patient had with their physical therapist.
Treatment can be delayed if the clinic needs to wait for authorization. That sudden stop can negatively affect progress and force patients to catch up.
An insurance company can decide to not pay for already-completed sessions. Because of the agreement between the provider and the insurance company by going in-network, the clinic can’t bill the patient and won’t be reimbursed.
Out-of-Network
There is no agreed-upon discount to insurers. Providers bill patients directly. This sounds like cost of care would be higher, but providers don’t have to worry about insurance companies’ limits and can develop unique plans for patients — who will receiver better and individual care. Who cares if Big Insurance won’t cover dry needling? If a patient wants it, they get it. The patient and therapist can continue building a one-on-one relationship focused on improvement.
The patient, not a faceless entity determines when they’re better. The patient and therapist can determine what “better” means. Is it walking? Or is it walking without pain? Or is it running? Or is it running a marathon? If you decide you’d like to learn how to exercise … the right way … you can do that. The patient is the center; it’s not trying to appease an insurance company.
Going out of network means Intown Physical Therapy can provide the quality of care every patient deserves … and needs. Not having to deal with insurance companies, who at the whim, can deny a treatment or limit the care of patient, that’s a win-win for the provider and the patient.
Special thanks to Ed Delagarza
