Why We’re Out-of-Network (and why it leads to better care for you)

by Dr. Sarah Joy White, PT, DPT, CD

We became physical therapists because we care so deeply about the people who come to our clinic. We get invested in you and your health, we love hearing about your successes. I can still remember so many of my past patients’ wins. The woman who could get back to playing pickleball. The girl who stopped wetting the bed. The man who biked to Canada. The person who could put on their shirt independently again. The woman who returned to working in her dream career after leaving it due to pain. And so many more! When I think about why I love being a physical therapist, these are the moments I think of, and these are the moments that actually matter to the people who come see me for care.

Unfortunately, these aren’t the things insurance cares about. Insurance companies make money when they spend the least amount of money possible. And year after year, insurance has paid physical therapists less for the same amount of care. Obviously, that isn’t sustainable, so what in-network clinics have started doing is shortening appointment times, having patients see physical therapy assistants, or untrained/unlicensed aides, and only check in with a doctor of physical therapy every 10 appointments. They also end up spending more time doing paperwork and arguing with insurance companies on your behalf, which limits their time with you. I can’t blame them, it’s what they have to do to stay open. But when we opened Vivian Joy Physical Therapy, we wanted to do things differently and put YOU and your care above all else. So allows our out-of-network clinic to provide better care?

1. We treat you as a whole person, not just an injured body part. Insurance pays based on diagnosis codes. So if you came in for shoulder pain, but you rolled your ankle this week, they often can’t work on both in the same appointment. We recognize that you’re a whole person, the body is highly interconnected, and you deserve care that’s holistic. Did you know that sometimes we can fix a knee issue without ever working on the knee? It all depends on the root issue, and looking at the whole picture. When we’re working for you, and not your insurance, we can do that better.

2. We provide longer appointments. Most insurance-based clinics offer 30-40 minute long appointments, and you’ll often see a PT for 10-15 minutes of that before seeing a PTA or aide for the rest of the appointment time. We don’t think 10 minutes is enough to learn about you, your goals, how you’re feeling that day, make a plan, and provide treatment. That’s why every appointment here is 50 minutes, one-on-one with a doctor of physical therapy, and your PT won’t be on their computer the whole time.

3. We provide the treatment that will be the best for you. Did you know that insurance pays differently based on the type of treatment you receive? Manual therapy, hands-on treatment, is the most skilled treatment that physical therapists perform. Yet insurance pays less for that than it does for you doing exercises off a list. So insurance-based physical therapists are encouraged to do little to no skilled manual therapy, and throw an ice or heat pack on every person regardless of whether they’d benefit from it. We are highly-skilled physical therapists with advanced training in manual therapy, and we refuse to let insurance companies tell us what treatment to provide.

4. We’re with you for as long as you need us. Insurance looks at numbers, not successes. If a physical therapist discharges you after 6 appointments, insurance thinks they’re amazing, regardless of whether you actually got better or not. So people get shuffled out the door quickly, and often end up with a new injury a year later. We won’t rush you. Some people see us for several sessions, feel better, and get the tools to work on things at home. Some people see us for longer to set them up for injury prevention and optimal health long-term. Some people see us every so often for “tune-ups” as part of their self-care. And some people see us regularly as part of their regular management for chronic health conditions.

5. You see the same doctor of physical therapy every time. Did you know that many PTs at insurance-based clinics are travel PTs? This means that you may work with them for only a few weeks before they leave the clinic and you have to explain your story to another person. And even if a clinic doesn’t hire travel PTs, they often will have you see a PT assistant, or an aide, for part or all of your appointment. At our clinic, you won’t get shuffled around to different providers, you won’t have to explain yourself multiple times, and you will have a consistent doctor of physical therapy on your healthcare team.

6. We see fewer patients every week, so we remember you, what’s important to you, and your dog’s name. In an insurance-based system, PTs often see 53 (or more) patients each week. Nobody can remember everything about that many people, so they rely on their notes to remember what exercises you’re doing, which side your knee hurts on, etc. We love getting to know you! We love learning about your passions and goals, hearing about your recent vacation, and seeing pictures of your kids and pets. We remember details of your care, but we also get to know you as a person.

We love what we do, and we want to provide the best possible care for the people who come to our clinic. That’s why we chose to be out-of-network. That doesn’t mean it’ll break the bank though. Some people choose to use their FSA/HSA card for appointments. We also provide superbills, that you can submit to your insurance for reimbursement per your out-of-network policy. It’s not a difficult process, and we can help you figure it out. If you want to experience the difference between “standard” PT and the physical therapy we provide, we’d love to see you! And if you have more questions, you can always book a free discovery call to chat with a doctor of physical therapy today.