Welcome to the PT Rebels Podcast.

This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible.

I’m your host, Dr. Gina Fick.

On today’s episode, we will discuss what it means to choose a physical therapy clinic that is out of network with insurance companies. One of the first questions that patients generally ask us when scheduling is if we’re in-network with their insurance company. We wanna talk to you today about the benefits of choosing an out-of-network physical therapy clinic versus an in-network physical therapy clinic, and what that means for your physical therapy care and overall recovery. Many insurance companies. Deter patients from going outside of their network because of the higher expense. We understand you’re paying a bunch of money every month for your health insurance, so why shouldn’t you use it and go to the doctor inside of your network and, you know, should you really bother paying more for a physical therapy service versus using your insurance benefits? Well, you know, that depends. Um, not all physical therapy care is equal. We feel like you get what you pay for. There are benefits to going in network and there are benefits to going out of network. I could probably write a book on the subject to be honest, but I’ll try to make it brief in our explanation. When a medical provider participates in an insurance plan. They’re only allowed to collect the insurance deductible and copay from that patient. So the remaining cost of the visit gets billed to the insurance company so that the provider as this physical therapist can get paid for the services that we provided to the patient. Problem with that is in this in-network scenario, the insurance companies tend to dictate what the provider can do for each patient in terms of the services permitted and the number of visits allowed. So for instance, if you had. For instance, if you had a rotator cuff repair, your insurance company has an algorithm that they follow for a typical physical therapy care plan for a rotator cuff repair, and they will allow you a certain number of visits for that diagnosis per calendar year. However, when you go to an out-of-network provider, we are not dictated by what we can and can’t do in terms of the plan of care and the number of visits allowed, so you get exactly the service that you need. Without having to worry about the insurance company telling you what they think you need. Generally, out of network physical therapists are able to spend one-on-one time with their patients. In our clinic, we spend the full treatment time with our patient. We don’t hire rehab techs, aids, or assistance to help us in that care. The care with our, with our patient is direct one-on-one time, whether that be for half an hour or an hour. You know, in network physical therapy offices are usually quite busy. And when you enter these types of clinics, you see, you know, large rooms with lots of tables and lots of patients around. And you know, typically there aren’t the same number of PTs as there are patients. There are generally a lot more patients versus the number of PTs in that type of clinic. So you can do the math and you know, and you can see the answer that most PT clinics have their PTC multiple patients at the same time. Usually only giving, you know, the patient a fraction of their hour appointment spent with the pt. That means your entire appointment isn’t just for you as a patient, but when you go out of network or cash pay, that drastically limits the overhead that the clinic is involved with it, with insurance, billing, and they have more flexibility. And the type of care that they provide because they don’t have to worry about the low reimbursement that drives many clinics that are in network to be forced to see multiple patients at once. So we only see one patient per PT at time. At a time. So when you come in for your physical therapy appointment, it’s just you and your physical therapist for the entire time, and that increases the time spent with your pt. Cuts down with the number of visits that you need overall because you can accomplish much more in a single session. A lot of busy clinics employ support staff to assist in their physical therapy treatment, and this decreases the amount of quality time that you get to spend with your physical therapist. And you have to switch between multiple people during either a single treatment session or you have to see multiple providers during your plan of care, and that really reduces the continuity of care from your provider. And at the PTM performance, we are all physical therapists. We work as a team to support one another, and we do not hire support staff who are not skilled clinicians. Oftentimes, even when you call our office, you’ll speak to a physical therapist. Your entire appointment is spent with your PT only, and you won’t get shuffled around to another physical therapist or to any type of support staff. This means that you get educated through your treatment. Can have adjustments made on the fly as needed with your physical therapist instead of just following a list of exercises that your physical therapist gave, or rehab tech, or aid to check the boxes off, you know, during your treatment session. And you always have the most highly skilled type of care or therapy eye on you during your treatment session to ensure that you’re doing everything right and getting the most care out of your visits. If you’ve been to traditional physical therapy before that is in that work, you know that. You often have a order from your physician that says you should go to physical therapy two to three times a week for 6, 8, 12 weeks, and that could end up totaling as many as you know, 36 visits, assuming your insurance doesn’t cut you off before that. But in the cash pay model, because of the one-on-one time that you get with your physical therapist, you usually need far fewer visits. Many of our patients only need to come once a week, and our average number of visits overall for a plan of care is about. Five to eight visits. So you know you can do the math on those numbers. You know what sounds better to you, five to eight visits or up to 36 visits. So although some patients are concerned that you know that we may be out of network with their insurance company, when you do the math, they actually may be paying a lot more for that in-network service because their visits aren’t as efficient and they’re having to go to many more visits with that physical therapist who’s in-network. So we wanna work to make sure that you understand what you need on your own at home in order to get better. And we also want you to have an understanding of why it’s important and how coming to PT doesn’t necessarily mean having to stop your favorite activities. And you know, not to mention, fewer visits overall means less time away from work. Your times of having to schedule, you know, a babysitter or a friend to come over and help in in, in Denver metro area means less time sitting in traffic on I 25 or four 70. So, you know, to be honest, we see our patients for much fewer visits than they would be seen in a traditional in-network physical therapy practice. In general, in our practice, we try to make sure that communication is is key and number one with our patients. So we try to be extremely accessible. Our patients know that they can call, text, email, message us through our electronic medical record system that we use. They sometimes even stop by in the clinic just to say hi or to, to let us know how they’re doing with their care plan. But we try to be extremely accessible because we feel like that’s really gonna help promote a more successful outcome with our clients. So if you’ve been to a bigger PT practice, you know that, you know sometimes if you have questions in between your treatment sessions. Chances are you’ll have to call and leave a message with someone at the front desk and then wait for a call back to get your answer. And sometimes that can take several hours, um, and sometimes days, honestly. So part of our treatment model is having open communication with our patients, and you can reach us anytime, like I said, between appointment, through a direct message, text, email, phone call. And we welcome that. We really want to stay on top of our communication with our patients, and we don’t want you to have to. We shifted through, you know, voicemails and, you know, a front desk person having to, you know, ask the physical therapist to call you back and getting lost in that cycle and chain. We, we make sure that we try to be very efficient with our communication with patients. What I’ve seen traditionally in, in network P TM, L type settings is that patients will come in and they will. See their physical therapist for a short period of time, and then that physical therapist passes the patient along to a support staff, rehab, tech assistant or aide that has a list of exercises oftentimes where their exercises that the patient’s already doing at home or could do independently. And so they check the boxes, the patient goes through the same exercise. That person who’s a support staff isn’t as skilled to number one, adjust those exercises, but they may not be. Aware of how to progress those exercises properly. And so sometimes I think what happens is a patient just gets lost in the cycle of coming in and kind of doing the same things over and over again. And I think that’s why a lot of patients just feel like they didn’t have a successful experience with physical therapy and they get frustrated and they do feel like it’s a waste of time and money. What we try to do at Thick Physical Therapy and sports performance is really check in with our patients at each session and do an evaluation of where their functional limitations lie. What our programming needs to be for that day, depending upon their limitations, their symptoms, and their goals. And so we adjust their treatment exercises and their also, their actually their entire treatment. We adjust their treatment to reflect the goals for that day, and we give them feedback on those exercises and we give them exercises to do on their own at home that are new and different based on what we’re seeing at each treatment session. So they’re very specific too. The treatment that we’re trying to provide for that day, for that patient, and for the functional outcome that they’re trying to achieve. And so we try not to give patients the same exact exercises that they could be doing on their home or that they have been doing for several weeks. When you go into your session and see your PT for a few minutes and you do some exercises with the support staff and then sit on some heat or ice or e stem for the last 15 minutes of your visit. We just don’t feel like that’s value-based care really. We just have a problem with that type of care. We don’t feel like that’s what you need and what you deserve, and that’s not fair to you as a patient. And we just don’t tolerate that type of care in our practice and we don’t promote it. And, um, we actually get quite frustrated when patients come in and tell us that that’s the type of care that they’ve been receiving. So it might feel good to sit there on those passive modalities, you know, but those, those types of things don’t ultimately fix your problem. And you know, as a patient, don’t you want your appointment to be spent on doing the things will actually address your problem and fix it. And those things are like manual therapy. Corrective exercises. Education. We don’t use a lot of past modalities in our practice that are inefficient because, because we believe that your time is very valuable and that your money is better spent doing the things that will make a lasting change and fix your problem and not just put a temporary feel good bandaid on it. We offer wellness, maintenance and injury prevention services to keep our patients healthy and active and happy. Unlike the annual checkup by your physician, most insurance companies do not cover. Musculoskeletal wellness or injury prevention by a physical therapist. They only cover those types of things if you have an actual injury or surgical procedure. And this is why you don’t typically find any wellness services at large outpatient physical therapy practices. However, these, you know, these types of services are incredibly important and much less expensive to prevent injuries than to treat them once they’ve occurred. It’s also less time miss doing your favorite things. If you can prevent these types of injuries as physical therapist, a sports physical therapist, we can prevent all injuries, but we can put you in a better position to become injured less frequently and to have. Better strength, range of motion, mobility and motor control during those functional tasks and activities and sports that you are participating in. So we would much rather work with patients on getting strong immobile and preventing injuries instead of treating ’em after the injury has occurred. If you think about the care model, you have annual physicals with your physician. Um, you take your car in for maintenance to prevent engine failure or, um, different things that could go wrong with your vehicle. You might even do preventative services on your HVAC system at your house. So why wouldn’t you do the same thing for your body? And again, we offer these types of services and we’re actually get very excited when patients wanna come in and work on these things because we know the outcomes that potentially happen in terms of. Less frequent injuries, less frequent pain, and better performance in their sports or functional activities that they’re participating in. I could never go back to working in a in-network physical therapy practice. And the reason for this is, you know, insurance companies reimburse the in-network physical therapist, a very small amount for each visit, and that’s, you know, obviously depends on the specific insurance plan and services delivered. But this creates a high volume or factory-like environment. Where the physical therapist has to see either many patients at the same time or throughout the day, physical therapist and in-network PT mill type setting might be seeing, you know, upwards of 20 to 25, sometimes 30 patients a day. And I’ve actually heard more horror stories where they see more. The result is less one-on-one care with your patient and you’re having to put your patient in hands of unlicensed staff. This can prolong recovery time. For me, it was an ethical dilemma to work in that setting because I knew I wasn’t providing my patients with the best type of care, you know, to be honest, with the higher volume of patients that we were asked to see. I went home as a young person, even just exhausted, worn out, feeling really burned out. And also I think the biggest issue for me is that I, again, had just a ethical dilemma or problem with treating patients in that way because I knew they weren’t getting the most out of each visit and I wasn’t able to provide them with the type of care and the level of care that I knew that was best for them. And so, you know, a lot of physical therapists that are in this type of setting, in network and, and bigger box and PT ML type setting, a lot of them are excellent physical therapists. They’re well trained. But they actually just can’t provide the type of care that they want to provide because they don’t have adequate time with their patients. And they’re being asked to see so many patients during the day that they’re pulled in multiple directions. They’re having to write their notes at the time of the treatment session. They’re having to, you know, deal with these insurance companies who are, you know, submitting denials back to them. So they have to prove to these insurance companies that. Physical therapy services are necessary, and all that takes a lot of time away from actual physical therapy care. And it’s just, again, like I, I can’t, I could never go back to that setting because number one, I just don’t have the, the energy from what, and I think the burnout level at this point would just be so high because on the flip side, I’ve seen how much patients can improve with a level of care that is much higher. I’ve seen the outcomes of their, um, overall satisfaction and functional progression and really just optimal results. At the end of the day, you know, we know it can be hard to understand why you should not use your insurance benefits to pay for physical therapy and instead pay out of pocket. And that’s why we get that question almost on a daily basis. If you’ve been to PT before and it didn’t work, or you felt like it was a waste of time, we encourage you to try a different model. That model we feel like is best when you go out of network or choose a cash pay physical therapist, you are absolutely allowed to bill your insurance company for out-of-network benefits. And so what we ask our patients to do is to call their insurance company and to determine what their out-of-network benefits are. So a lot of patients don’t understand that they have in-network benefits and out-of-network benefits. So an out-of-network provider either chooses or has been told that they cannot go in-network with that insurance company. You know, some common insurance companies are Blue Cross Blue Shield, Cigna, UnitedHealthcare, Aetna. These bigger insurance companies will allow you to have a network or out-of-network care. Oftentimes the insurance companies will really deter you from going to an out-of-network clinic because they profit more from you going to a network clinic. At our practice as a physical therapy owner, I pay for a service called Reimburses for our patients, reimburses a third party service that patients can use to submit their claims for out-of-network benefits. It’s very simple, very streamlined. We actually have a link on our website if you go to our website. It’s www.fitptandperformance.com. And if you click on the current patient’s tab, at the very top, there’s a dropdown menu that says, bill my own insurance. And so you can click on that tab that says, bill my own insurance. Put in your information. You can upload your super bill or your invoice that we give you at each visit, and you can submit that for out-of-network benefits. And we have patients that are. Submitting their out, out-of-network benefits and getting reimbursed anywhere from 50 to 70% on those claims. So if you do the math and you’re seen for, you know, six to eight visits versus 36 visits in an in-network clinic, and you’re getting 50 to 70% of that reimbursed your actual overall cost, it’s gonna be much lower added out-of-network facility like ours. Some physical therapists, you know, feel like that it’s a ethical dilemma in one sense that they don’t take insurance because they can’t help everyone. But you know, we’ve had to make the choice and decision to give the highest level of care to the patients that we can see. Because if we choose a model where we try to treat everyone under the in-network setting, we are providing less than optimal care to everyone. And so it’s just a decision that we’ve made as a practice. And where we wanna go with our practice, because we feel like that’s not only top-notch care, but that’s what’s gonna deliver the best results. And in the end, that’s what’s gonna give us the higher, highest amount of integrity for us as physical therapists in the community, to become known as the experts in our field in this community, and set us apart from the rest.