Here at N-Balance Physical Therapy our business model is to treat each patient one-on-one for up to an hour with a Doctor of Physical Therapy in every session. With this approach we usually only need to see the patient once per week. Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapist at in-network clinics must see at least 2 patients per hour (sometimes more) and often use technicians and/or assistants to provide much of the actual patient care. Most of the patient’s time at the clinic is spent doing exercises that they could do on their own time and do not receive much hands-on treatment. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week.
If you consider the time savings of fewer trips to the clinic, time off work, or finding and paying for childcare this out of network expense is a huge bargain. On top of that the out-of-network session cost is sometimes less than a patient would pay at a clinic that accepts and bills their insurance. You might ask yourself how is that possible? As deductibles and co-pays have increased over the years, many patients are having to pay a higher co-pay rate (every visit), or they might be meeting their deductible (which means they pay 100% of the services due that visit). Depending on where you go for example, a hospital based out-patient physical therapy clinic, their in-network rates could range from $250-$350 per visit.
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours. So, to weigh your options, it’s very important to:
- Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet). If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company. In most cases, you will ultimately be paying the full bill until your deductible is met.
- If you have met your deductible, ask how much your copays will be? Ask, how many times per week the average patient is asked to come in for treatment?
- Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
- Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find! With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment. The amount of reimbursement or application towards your deductible is completely dependent on your insurance plan. If you call your insurance company to inquire about what you can expect to receive, you should ask about reimbursement for “out-of-network Physical Therapy” expenses sent in via self-claims. We are here to help you through this process and can assist you in finding out what your benefits are. Call our office at 972-722-1212 for assistance.
Can I bill my insurance for reimbursement of my out-of-pocket expenses?
This depends on the insurance you have, but YES, most NON-Medicare patients can send “self-claims” to their insurance company for their treatments at our clinic. You should be able to print claim forms off of your insurance company’s website and send it in with the needed receipts and treatment codes that will be provided at our clinic.