Why go out of network?
We are often asked why we are not in-network providers with insurance companies. Physical therapists are commonly in-network, and there are lots of questions about the costs and benefits of going out of network. There are lots of reasons that this works well for our practice and for our patients.
The value of going out of network
No hidden fees
Some services provided at off-site clinics owned by hospitals will include the billing for the treatment as well as something called a facility fee. This is an additional fee added to the total cost of treatment to help hospitals cover general infrastructure and other costs they are not otherwise able to charge for. Insurance companies may or may not cover the facility fee as part of your plan, in which case you will pay your copay at the time of treatment and get a bill for the facility fees later. Despite having an in-network plan, you may be paying for the cost of fees unrelated to your care.
At our practice, there are no hidden or added costs for the treatment you receive. The cost of each visit is a flat rate, and there is no surprise facility fee. We submit claims on behalf of our patients for no additional charge, and your insurance company will reimburse you directly once you have met any deductibles and co-insurances. If you compare the out of pocket costs associated with in-network (copays, deductibles) with out of network (deductibles, coinsurances), you may pay slightly more for each visit. However, bear in mind the other benefits of going out of network and consider whether a different setting may be a better fit for your therapy needs.
More time and access
In-network practices negotiate rates with insurance companies to determine the amount that they will be paid for a visit. Payment may be a flat rate per visit, or may be a percentage of the total amount billed. This is why you may notice a difference between the rate your provider charges and the amount the insurance company pays. While copays have continued to increase for patients (meaning you are paying the lion’s share of your therapy), reimbursement has not increased to the same degree for physical therapy services. In many settings, this has lead to therapists treating more patients in an hour, spending less one-on-one time and/or in more delegation of treatment to assistants or technicians to remain profitable. This means: a) less time with your therapist and b) more patients for her to manage and oversee.
As an out of network provider we have more time to devote to our patients both in the clinic and to help facilitate referrals, manage your case and answer questions that arise between visits. Access to your therapist means more personalized attention and care. This works especially well for those patients who are dealing with chronic pain, anxiety, or prefer the one-on-one environment that we provide.
Why choose us?
Experience: We have over 30 years of combined experience as physical therapists and have dedicated most of our clinical practice to treating men and women with pelvic symptoms ranging from incontinence to pain to sexual dysfunction. Emily is a Board-Certified Orthopedic Certified Specialist and Sarah is a Doctor of Physical Therapy. Both Sarah & Emily regularly participate in professional education specific to complex pelvic patient diagnosis and treatment. Our therapists have both practiced in the Triangle area for several years and have developed relationships with other professionals locally, regionally and nationally, which allows us to optimally coordinate care for those requiring referral and additional care.
Environment: Our patients notice the difference from the first visit- we do things differently here! Our clinic environment is intimate, with a small waiting area, small gym and private treatment rooms. Unlike other practices that share space with orthopedic patients, there’s no long walk to the private ‘pelvic room’ with the ‘pelvic therapist.’ As a small practice, we strive to provide unparalleled customer service from the first time you call until the last time you leave. From the beginning you are treated as part of our Carolina Pelvic Health Center family.
Time: We schedule appointments on an hourly basis. This means that your session includes time for questions in addition to treatment. Each visit is one-on-one with your therapist, and you will see the same person every time unless you request otherwise based on scheduling needs. We are able to give you focused attention to make sure that your goals are met and that you understand your treatment plan and home program.
One-On-One Treatment: Out-of-network providers are able to make decisions for your treatment based on individual need, not according to your insurance benefits. This means having the time to tell your story at your first visit and follow up appointments, ample time for treatment as well as exercise instruction and questions throughout the session. Patients are not shuffled between different providers during sessions. All patients are given one-on-one attention AND are active participants in their treatment programs.