Why You Want Out-of-Network Physical Therapy

I love my job. I love my profession. Learning about the body, how it heals and knowing techniques and exercises to help people manage pain, meet goals and get back to living has been one of the best decisions I have made. As I have worked and gotten to know my profession and our health care system in America, it has become glaringly obvious that my ability to help people is dictated and hindered by insurance and healthcare policies.

What in-network physical therapy usually looks like

After working for 5 years in an in-network facility, the amount of instances patients were denied services, or their treatment was delayed due to paperwork and insurance hang-ups is astronomical. Over the years, reimbursement for therapy services has gotten less and less, which has backed most, if not all in-network facilities into a corner. If you have ever been to an in-network facility before, maybe a few of these forced practices sound familiar:

• 2-3 (if not more) patients at a time per therapist
• Limited time working with your therapist
• Exercise/drills supervised by therapy techs/assistants
• Multiple modalities (ice, heat, e-stim, ultrasound) performed each visit (and billed for all)
• Multiple treatments per week

Unfortunately, this is how clinics have to function to make any sort of profit as well as to get their patients better. With reimbursement rates dropping, clinics are forced to follow a model where insurance dictates all.

Why PeakRx chose to be out-of-network

When I opened PeakRX, I knew first and foremost, I wanted to operate under a different model. To provide my patients with the best, most ideal treatment… So being out-of-network was a must. I believe firmly in the following ideas and are foundational to PeakRx:

• I believe that every manual technique, corrective exercise, and drill given requires the eyes and mind of a doctorally trained therapist and not some high school kid working a summer job.
• I believe that if patients are owners of their bodies and take their treatment seriously, 2-3x/week visits (can be) overkill and unnecessary. Discharge rates and visits used are almost half at PeakRX compared to others due to increased one on one time with patients and patient-specific home exercise programs.
• I believe that having shoulder pain in an overhand tennis serve or pain in the bottom of a squat are major problems when it comes to quality of life. Some insurance companies deem this “not medically necessary” and deny coverage.
• I believe in evidence-based practice and research. This means using disproven modalities (In certain instances) such as e-stim and ultrasound and then billing patients is not apart of my practice. Each exercise issued and modality utilized will be thoughtful and purposeful as to save my patients time and money.
• I believe in getting people better quickly and educating them on taking care of their own bodies. So if this means they are well and independent after 2-3 visits, then I see them for 2-3 visits. I do not believe anyone should ever be reliant on any healthcare professional for life if managing their injury without supervision is possible post-treatment.

How out-of-network PT works with your insurance

Healthcare is changing. Now with more high deductible plans, most people will be paying out-of-pocket anyway, at least for a while. I believe in the importance of investing in your body, so ensuring your choice of practitioner allows you to maximize your return on your investment is a high priority in my mind.

Luckily, most insurance companies do have out-of-network benefits. So if you go with a practitioner like me, who is out-of-network, then you can still file with insurance to save some dollars, if possible.

In need of treatment but still unsure about out-of-network? Reach out to PeakRx and we can walk through our out-of-network policies and see if we are a good fit for each other.