During the Covid-19 crisis, schedule a virtual Telehealth visit with one of our experienced therapists

Understanding Commercial Insurance-Part 2

In the last blog, we talked about the major types of commercial insurance (Please see the previous blog). In this edition, I’d like to explain what the differences one would encounter in physical therapy provided by an ‘out of network facility’ (OON) compared to the services one would receive in an ‘in-network facility’ (IN).

Let’s first look at an IN facility. The IN providers are generally seeing 2-3x as many patients in an hour than OON providers. This is usually accomplished by having multiple assistants of varying levels of training helping the PT provide your care. Often the PT will evaluate you on your first visit, design a program for you then transfer much of that program responsibility to an assistant. In some settings, you may receive10-15 minutes of direct care of one sort or another from the PT each time you come in, and in some settings, your original PT may not see you for 2 or 3 sessions, with care being delivered by assistants under the PT’s supervision, often distant. You may be given a set of exercises that you are then expected to do, often by yourself without supervision. So what does this mean for you the patient? It means that you may be doing exercises without knowing whether you are doing them correctly. You may also not be getting the necessary education about your problem, and what you may be able to do to reduce your risk factors for it occurring again. This certainly can have an impact on your care. Now understand that this is not by intent or design of the providers in these settings. They want you to get better, but the circumstances dictated by the insurance companies on the IN facilities make delivering quality care more difficult.

So what are the differences between PT services provided at an OON facility? There are many. First of all, you will usually find the volume of patients in the office will be less. This is simply because OON providers don’t have to schedule as many patients in an hour to meet expenses. The atmosphere in this setting is likely to be energetic but not frenetic. The PT that you see on your first visit is the PT who will be with you throughout your entire program. He or she will truly have an opportunity to get to know you and your problem and will be able to assess your progress more comprehensively. Each session, you will be seen by that PT for 30-60 minutes throughout the duration of your care. The likelihood that you will receive better care is high. One of the basic foundational characteristics of virtually all PT’s is that they are educators. This is a crucial aspect of anyone’s care during a PT program, regardless of what problem you the patient may have. In the OON facility, there is the time that is needed for this education to occur. The education of the patient is important in order for you to understand the problem, thereby engaging you more in your own recovery. It is also critical to be able to reduce risk factors for a recurrence of your problem. As you can see, the differences between the two types of facilities are significant and can have an impact on your care.

Churchill Orthopedic Rehab (COR) is an OON practice. Not only are we expertly qualified to provide you with superb care, but we always exceed expectations. Our entire team is cohesively bonded to the concept of customer service, which is a rarity in these times in healthcare. The major hurdle for most patients who have an insurance plan with out of network benefits is getting past the deductible. These deductible sizes have increased dramatically over the past 2-3 years, which is by design of the insurance companies to discourage you from going out of network for your care. At COR, we can’t make your deductible disappear but we do have a number of ways to help take the sting out of paying it. So unless you have experienced PT care in both types of settings, you may not even know there is a difference. Whether you choose our practice, or another OON provider the next time you need PT, consider what your health and well- being is worth.

Tell a friend:

Share on facebook
Share on twitter
Share on linkedin