Is going fee-for-service more costly than staying in-network: a physical therapist’s perspective

I am writing this post from the perspective of an owner and physical therapist of a fee-for-service clinic so I am biased. However, I have also been a patient as well and am a stickler for value. I spent the first seven years of my career as a physical therapist working in multiple settings including a physician owned clinic, drug rehab clinic, hospital owned clinic, and a privately owned one-on-one clinic that was in network with several major insurance companies.

The first thing to keep in mind is that yes the price per session will be higher when going out of network with a fee-for-service provider. If that was the only factor and the number of visits required to meet your goals was the same as when using an in network provider it would be a no-brainer. Even I would quickly choose to work with the therapist that was in-network. Who doesn’t like to save some money when possible?

Unfortunately, it is not that simple and straightforward. Insurance has been increasingly more difficult to use and more restrictive in terms of what it allows the therapist to do to get the patient better. Co-pays have been consistently increasing and I don’t believe that will change any time soon. More and more wonderful healthcare providers are moving to fee-for-service and it isn’t because they are greedy or trying to be difficult. It is because they believe in their value and want the best possible outcomes for their patients that they courageously transition to a fee-for-service solution.

Integrity is another factor. Often the lines are blurred for a healthcare provider when trying to appease the insurance company and keep their doors open. When choosing a fee-for-service provider, you and the therapist you choose to work with establish a very up front and clear contract that states that in exchange for the hourly fee they will be free to use whatever means necessary to get your better as quickly as possible.

All costs are very clear. How many times have you paid your co-pay thinking that the rest may be covered only to receive another bill or two asking for more money. At this point you as the consumer have no say as to what you are charged. You can contest it, but that will use up a lot of your earning time to do that making it not worth it. How many other scenarios in life would you be comfortable having no control over the bill after the service is over? It is surprising to me that we readily agree to this kind of transaction so easily.

Other reasons choosing in-network may not be a smart choice.
-Rising deductibles
-Low quality of care
-One of many patients, no individualized attention
-Getting better is not the top priority
-More frequent visits per week
-Visit limits
-Waiting for approval, timing to begin PT is a priority when wanting to get best results.
-Not all physical therapists are equal