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.
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:
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.
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.