When I started my business, it wasn’t a quick decision to be an out of network provider. It took me some time to weigh all the circumstances that will affect my decision to start my business as such a provider in the physical therapy industry.
It was a difficult decision to make not to have a contract with a health insurance plan provider because when I was in physical therapy school, there were many discussions about the importance of health insurance and how it can be helpful for people who have difficulties accessing care out-of-pocket.
Another reason why it was a difficult decision for me was because I believe in universal health care as it is something that the United States cannot come to agree upon.
My Experience When I Started My Career In An Outpatient Clinic
I started my career in physical therapy at an outpatient clinic and I was seeing sometimes up to 20 patients a day. I was tired with all the paperwork that had to be done and the quality of care I was providing to my patients was not that great. It was a frustrating way for me to treat but the reason why I was seeing so many patients a day is because the reimbursement we get from health insurance is not commensurate to the services we provide.
For example, I might see a patient who pays a $20 co-pay and I may bill a certain amount. The health insurance will only pay $20 back for that so the whole visit amounts to $40. I only got paid $30 per hour that time to treat and it does not work out well business-wise. I had to see more patients to make up for health insurance that wasn’t necessarily reimbursing well. In line with this, some physical therapy clinics or health care providers do not accept certain insurances because they don’t reimburse well. This scenario is frustrating for both the consumer of health insurance and for the healthcare provider.
Further, for me, I wanted to provide the best service possible and get paid for the time I spent. That’s how our society works right now as we pay for the energy exchange of services.
So, as you can see from this experience, it became really exhausting and my quality of care wasn’t great. This was one of the reasons why I finally committed to being an out of network provider.
The Difference In The Quality Of Care I Provide Now VS Then
Like what I said above, the quality of care I provided when I worked at the clinic decreased dramatically as I was seeing a patient for an average of 12 visits. But now that I am an out of network provider, the average number of visits I see a patient is only four.
The reason for the decrease in the number of visits is because I get to see them 1:1. I am also not seeing so many patients in a day that my brain can no longer decide what’s the next best action.
What Health Insurance Does That Limits Providers
The other thing that health insurance does that limits providers is they can reimburse for certain treatments only. For instance, if I think that it’s important to educate my patient on pain so they have power and understanding about how to deal with their own pain, some insurance companies won’t pay for the time I spent talking to a patient regarding this matter.
So, that means I have to decide how I’m going to do my clinical care based on what the health insurance company dictates. That also can mean not as great outcomes for my patient because I am not doing everything I know in my power to help them get better.
The other frustrating thing about health insurance and why I chose to be out of network is you have to negotiate your terms with them. So, I would have to be on the phone with a health insurance agent and try to negotiate how much they should be reimbursing me for certain services. Negotiating my rates is also not a good use of my time as I’d rather be treating patients and helping them feel better. I would not want to worry about the money coming in so I can continue to keep my doors open and continue to help patients.
The contract will then stay in effect for a number of years. They can, however, change the terms of service any time. What’s unfair is if you look at big hospitals, health insurance companies reimburse them better than a mom and pop clinic, which I consider myself. With these reasons, I felt that being an in network provider will not be cost-effective for my business.
Conclusion
I know that many physical therapists are fighting the good fight to try to get us to be reimbursed better. It’s great that physical therapists are doing that but honestly, the change should come from the consumers. If you are somebody who wants to see better reimbursement for physical therapists as a consumer, the way that that will change is from you as the patient calling your health insurance company and telling them you want certain services covered. Maybe this will help create changes eventually.
I hope that this blog helped you understand about health care providers choosing to be out of network and how health insurance works.