For many private practices, the "out of network" model couldn’t come at better time. With rising business costs, coupled with decreasing reimbursement rates and low per-visit rates, it has been harder for insurance-based practices to survive. Health care providers are drowning in paperwork, as they must see two to three times as many patients just to generate the same revenue as they did a decade ago. The traditional “in network“ practice model is proving to be less financially viable. The "out of network" or cash based practice model is relying less on insurance payers and more on the cash value associated with your time and skill set. As a physical therapist, I am trained to be an expert in identifying and treating musculoskeletal conditions – not spending the majority of my day on the phone with insurance companies, tracking down payment.

Now the question is why would someone come to me, an "out of network" or cash based provider, when you could see someone in-network instead? When we see a private insurance patient, we expect payment time of service, however we can then give the patient a document that they can submit to their insurance company for any "out of network" benefits/reimbursement. Patients who are interested can call their insurance company prior to their visit to verify their benefits. They will know exactly their percentage their insurance company will reimburse them before stepping in my door.

Another point to consider is an "in network" clinic may still require a copayment of $30-$70 each visit, with a bill you receive from your insurance company weeks later for an amount you're still responsible for. Since our practice is "out of network" we do not collect copayments. The difference between a patient's copayment and what we charge for services may be the same - or not much more. Again, why would someone come to us instead of going to their “in network” provider? They can come to us for conditions that take longer to treat knowing that their chances of having a good outcome are enhanced if they have the best possible therapist that their money can buy; whether you’re in or out of network, you may still have to pay a deductible either way.

Practitioners find that the restrictions placed on their services by third party payers interfere with their ability to help patients reach their goals. For example, if someone comes with complaints of left knee and the reason for their pain is from a mal-alignment in the pelvis, causing mechanical stress to the inside of their knee, an in-network setting will have a script for left knee pain but the documentation says there was manipulation of the right hip, most likely you will be denied reimbursement because the therapist was working on something other than the left knee.

By not having to abide by the restrictions that are forced by third party payers, we are able to apply a full body approach with all of our patients - resulting in quicker and better outcomes. We spend more one-on-one time with every patient and improve our services to patients by providing clear information about costs upfront. This ultimately allows us to do what we were trained to do and not worry about chasing down payments from insurance companies. 

Jason Knicely, PT, DPT, MTC, CDNT

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