In-Network vs. Out-of-Network Physical Therapy: What’s the Difference?

What is in-network and out-of-network physical therapy?  In-network physical therapy is a service that is covered through most common insurance companies.  You often get a set amount of visits that you pay a co-pay for, which must also be prescribed by a physician.  

Out-of-Network physical therapy is not covered by physical therapy.  This allows you to have unlimited visits at a set price without the need for a physician's prescription.  

Most of the time there is confusion as to why someone would even bother seeing an out-of-network physical therapist if they could just go see one that is in network.  I fully understand this confusion as the out-of-network physical therapy model is a newer option.  

The biggest difference outside of payment that I see is that in-network physical therapy can only treat one body part that is listed on the prescription while an out-of-network physical therapist can treat the entire body with no limitations.  

The goal of the article is to highlight key differences and why out-of-network PT offers a more comprehensive approach.

What Is In-Network Physical Therapy?

Definition: Providers who contract with insurance companies.

As mentioned briefly above, this comes with its limitations as they are only able to focus on a single body part due to insurance restrictions.  So this means if you are having shoulder and knee problems you can pick one body part, get a prescription and head to physical therapy for that body part.  Once you complete care you can get another prescription and head back to physical therapy for the other body part. 

The number of visits you get is based on your insurance coverage and not what your physical therapist believes you need clinically.  The treatments chosen and used are dictated by insurance guidelines as well and again not fully based on the clinicians expertise.  

A common experience at an in-network physical therapy office is that your physical therapist will see multiple patients at the same time.  Potentially four in an hour.  In order to do this they utilize the help of physical therapy aides.  Many in-network clinics often put their patients on ice, heat and/or e-stim at the beginning or end of their visit and although it can be for clinical reasons, oftentimes it is more for insurance reimbursement reasons.  

What Is Out-of-Network Physical Therapy?

Definition: Providers who do not contract with insurance but offer superbills for reimbursement if you have a PPO insurance.  

Being out-of-network allows for a comprehensive whole body approach.  Stated simply, your physical therapist has the ability to treat the whole body rather than one body part.  What this means clinically is that we are able to address the root cause, not just the symptoms.  

For instance, your back pain may actually be coming from decreased ankle range of motion.  Your out-of-network physical therapist will be able to diagnose and address this without an updated prescription.  

Your treatment plan and visit total will be based on your physical therapist's clinical judgement, not limiting how long or for what goals you can be treated for.  Your care is based on what you truly need.  

This model allows you to receive more one-on-one care as our doctors spend 50-60 minutes with you each session and do not use aides. Each patient's care is customized to their unique needs.  You won’t be:

• Left in the corner on ice/heat and stim
• Handed a sheet of exercises to work through 
• Be cut short in your care because insurance says your coverage is done

Common Concerns About Out-of-Network PT

• “Is it too expensive?”
  • This is a question we get often.  I can’t really answer for you what is too expensive as we all have different financial abilities at different points in our lives.  What I can share is the value you get by seeing an out of network physical therapist.  By not needing a prescription therefore avoiding the back and forth of getting to a doctor to get that and then getting to spend a full hour with your doctor and them having the ability to treat your full body you will save a large amount of time and in the end.  

We also have no surprise bills, you know exactly what it costs right from the beginning.  We have heard so many stories of people finishing their in-network physical therapy only to get a sneaky bill in the mail for thousands of dollars.  

• “Will my insurance cover anything?”
  • If you have a PPO insurance plan and you do not have medicare we are able to give you what is called a Superbill.  This is a very specific receipt that your insurance uses to reimburse you depending on your plan and deductible.  

• “How do I know it’s worth it?”
  • I think the best way to see that it is worth it is to hear from our clients themselves.  Read the couple testimonials below!  

Real-Life Success Stories

Key Differences Between In-Network and Out-of-Network PT

• Scope of Treatment: Whole-body vs. single body part.
• Decision-Making: Clinical expertise vs. insurance restrictions.
• Treatment Frequency & Duration: What’s needed vs. what insurance allows.
• Quality of Care: One-on-one attention vs. high-volume patient loads.
• Long-Term Outcomes: Preventing future issues vs. symptom management.

Why Out-of-Network Physical Therapy Is Worth the Investment

Not only will you get a faster recovery and better long-term results. Your sessions will be more efficient since we will be able to treat you as a whole person. You will experience a truly individualized plan designed for lasting success.

We encourage you to try it for yourself!  Click the link below for a free 30 minute session with one of our doctors.