Why should I choose an out of network PT provider over utilizing my insurance?
This is a common question because the traditional medical model emphasizes the use of insurance. The common question when assessing where you go to physical therapy is, “Do you take my insurance?” Unfortunately, the decision on a medical provider can be steered by insurance contracts rather than who is the best fit to help a patient or client achieve their goals. By choosing an out-of-network provider, you are making a choice based on the provider and their ability to help you along your physical therapy process.
For years I worked in the insurance-based PT world where I would see 2-5 patients per hour which allowed me just enough time to greet them, see how they were doing that day, assess where they were in their rehab process, do some manual therapy, and then pass them on to a physical therapy tech to do exercises. This is the traditional outpatient model, and it is broken. It is not fair to the patient and it’s not fair to the physical therapist. The patient can get stuck in a wheel of constant therapy where they get better but at a slower pace, it is hard to customize treatments, and they spend a lot of time doing exercises in the clinic they could be doing on their own time. For the physical therapist, it leads to mental and physical fatigue which can lower your quality of work and leads to PT burnout which is a huge problem in our profession.
I left the insurance model and chose to move to an out-of-network model because I knew there was more to the profession that what I was getting. I wanted better for my patients, and I wanted better for myself. When I was treating 4-5 patients an hour, I would scramble to make it through the day, leave work and go to the gym, then go home eat and finish documentation for another 1-2 hours. It is very hard to do this day in and day out and still provide a high level of care which is why I opened Laws of Motion Physical Therapy.
How does this benefit my clients?
Allows me to treat the person, not a diagnosis
Under the traditional medical model, I could get a patient with a diagnosis for shoulder pain for example. For my treatment I would obviously treat the shoulder and I could easily justify assessing and treating the neck and the mid back but anything beyond that took some creative documentation to justify treatment in other areas. Did you know visceral (organs) restrictions can cause shoulder mobility deficits? Poor pelvic mobility and stability in certain planes can change the way a person moves causing increased shoulder dysfunction. Inefficient foot and ankle mechanics can cause issues from the ground up leading to changes in the kinetic chain. (Think foundation issues can cause cracks in the walls in your home)
A person may get a referral for PT and coverage for the time it takes them to recover from a surgery and get out of pain, but their benefits won’t cover an improvement in function to the point where their shoulder can perform the way it did prior to the injury that caused surgery. The length of coverage doesn’t consider a person’s actual goals, just medical goals to get them back into a range of motion within normal limits but ignores performance aspects.
At Laws of Motion, we strive to discover the root cause of a client’s dysfunction that led to a breakdown in the kinetic chain and to the eventual injury. We can go beyond getting someone pain free and get them to the point where they feel comfortable returning to their activity and at the same level, or better level, of performance.
One-on-one customized care
Every person that requires physical therapy is different. They have different injuries, different goals, and different personalities that make it necessary to provide customized care. Even those that come to physical complaining of the same type of pain, back pain for example, need to have a personalized plan that fits their abilities, time commitments, and lifestyle. Working one-on-one with a physical therapist allows us to maximize your progression through your rehabilitation and progress manual techniques and exercises that support personnel just aren’t trained to do. While it is true that exercises may overlap from person to person, it shouldn’t be a cookie cutter program that progresses everyone at the same time in the same order. At Laws of Motion, you get the personalized care you deserve with Doctors of Physical Therapy that help individualize your plan of care to help make you successful in achieving your potential.
If you have ever gone to a medical provider in the past and you paid your copay at the time of your visit and then received a bill a month later, this section is for you. While copays are on the rise, insurance plans still have out-of-pocket deductibles to be met which means your copay is not the only thing you are paying for with each visit. The remainder of the bill is based on billing codes that are used which can (and probably should) vary with each visit. The amount that is charged for these codes is negotiated between the insurance provider and the health care provider or the organization and varies plan to plan. Therefore, calling a provider and asking them “What is the total charge of each visit going to cost?” is a next to impossible question to answer. There is very little clarity in the cost of each visit.
The out-of-network model allows me to set my own prices based on what I am worth. If you were to ask me how much each visit will cost, I can give you a concrete number with no guesswork involved. I sell individual plans and packages to help the clients get their per-cost visit down. I also work with those that need to utilize payment plans to get the care they deserve. With Laws of Motion, there are no surprise charges or bills received months later.
Allows us to go beyond current rehabilitation goals
Not all goals are created equal. The standard PT model is one that sets goals to achieve objective measurements “within a normal range” to be able to perform an activity. While on the surface this may seem like a reasonable goal it doesn’t consider a few key factors. First, there is little mention or stock put into what level the client desires to achieve. This is especially true if it is above and beyond normal goals. Second, range of motion and strength goals are often key but there is little mention about the endurance required to do some activities. Third, and most importantly, many goals are centered around getting the patient out of pain, not optimizing their performance. It is often accepted that once you start having pain, you’ll likely have some level of pain you must, “deal with”. While this may be true in some instances, it shouldn’t be so readily accepted that there must be pain with an activity just because their once was. In fact, I would argue that, with the right PT, you can maximize your performance and return to activity in better condition than preinjury. Insurance based practices cannot go above and beyond because insurance can deny their claims because a patient has already reached the “normal” limit of performance which can leave many wanting more.
Concierge client care
Every patient has direct access to their physical therapist allowing them to text, email, or call with any questions between appointments. This can become the most valuable aspect of our treatment model because it allows our clients direct access to us to ask questions about exercises, updating us on doctor visits, confirming or scheduling appointments, and so much more. There are no insurance-based models where you have this kind of access to your healthcare providers because they simply don’t have the time to dedicate to their client.
The Wrap Up
Providing premium physical therapy truly is a passion and it is very hard to utilize our full skillset when our time with patients can be so condensed. While we know there are many options when choosing physical therapy, we hope that you give us a chance to help you achieve your goals. Please email firstname.lastname@example.org or call 602-598-1323 to talk with a PT and schedule your free 30-minute consult today!