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  • Writer's pictureSarah Barbosa

Why I am an Out-Of-Network Physical Therapy Provider

Updated: Dec 26, 2023

One of the most common questions I get from prospective patients is "Do you take insurance?"

Everyone naturally assumes you need to use your insurance for physical therapy. And if you're presented with a physical therapist who doesn't take your insurance, your instinct might probably be to look elsewhere until you find someone who does... BUT WAIT! There is a difference between a physical therapist who takes insurance versus one who is out of network.

Let me explain why I've purposely chosen to be out of network and not accept insurance...

In most cases, if you go to a physical therapy clinic that accepts your insurance, you will probably experience some of these scenarios:

  • you get put on a bike or treadmill to "warm up" (for subpar exercise to follow that probably wouldn't even require warming up for...)

  • you get to spend maybe 15 minutes with your physical therapist even though you are there for an hour or more

  • you get pushed off to an unlicensed professional, such as an aide or student, to help you with exercises or treat you while your physical therapist is busy working with another patient

  • you're handed an exercise sheet and told to do the same exercises over and over again

  • during YOUR appointment, your physical therapist has at least 2 other patients at the same time

  • you're told you need to go 2-3 times per week for weeks on end, and sometimes there isn't an end in sight

  • you have no contact with your physical therapist beyond your treatment session

  • your clinic is only equipped with light dumbbells at most

  • you get bounced around seeing different physical therapists or students each session and you never know who your session will be with

  • your physical therapist isn't an expert in your sport and isn't an athlete themselves

  • you waste about 15 minutes sitting with e-stim and either an ice pack or hot pack (these have their time and place, but most of the time will not make a significant difference in your condition)

Shall I go on? What does all this have to do with insurance, you ask?

Here's the answer: Since insurance companies don't reimburse much for a physical therapy session, physical therapists end up having to see multiple patients per hour in order to make a profit. The result is less time spent with your therapist, more time spent with unlicensed people, which results in needing to see your therapist more frequently throughout the week, more sessions overall, slower recovery, less quality of care, and MORE cost to you because of all of that.

Now the insurance model of care might be good for some people, but for a high level athlete or anyone who wants quality of care to get better the right way and the fastest way, in network PT may not get you there.

My high level powerlifting friends have told me their Doctors advised them NOT to go to physical therapy because they won't get the care they need in a typical PT mill. It's true. Not only are most PT clinics not built to work with lifters (in terms of time spent with patients and actual equipment they have), but most PTs aren't familiar with how to rehab someone back to lifting heavy weight, let alone do they actually do it themselves.

Here's why I don't accept insurance:

  • So I can be 1:1 with my patients

  • So each appointment is consistent. Every minute of every session is with me. You'll never be handed off to an aide or student

  • So I can properly instruct exercises. I make sure patients are doing exercises right including being in the proper position for the desired result, ensuring the correct muscle activation, and modifying it if it causes symptoms

  • So I can treat people who want to achieve goals more than just activities of daily living, and to an insurance company, would be deemed "not medically necessary for PT" because they're too advanced

  • So I can help my patients get better quicker as I have more time to spend with them to educate them on their condition, provide quality treatment and ensure exercises are done right

  • So I can be accessible throughout the week if my patients have any questions or want to share that they had an awesome workout with no pain!

It may seem like it may be more expensive at first, but because it's so much higher quality of care, you WILL get better quicker (assuming your condition will respond to PT in the first place and does not require other interventions like injections or surgery) and require LESS visits, making it less expensive in the long run.

I promise you'll see the difference in care. Give it a shot. Reach out to me and schedule an evaluation today!

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