Why Do I Have an Out-of-Network Practice?
Insurance Companies Do Not Consider the Following Factors When Determining Payment to Physical Therapy Providers:
The majority of in-network physical therapy facilities see each patient 2-3x/week, which significantly increases the overall cost of care with a co-pay required for each visit. However, I maximize each treatment and therefore see my patients only 1x/week without any co-pay and progress the home program with each treatment, because I only evaluate and treat one patient at a time for a full hour as follows:
In-network facilities commonly require each physical therapist to treat more than one patient/hour. In many instances, patients spend a significant part of each treatment receiving passive modalities such as electrical stimulation and ultrasound, and/or doing exercises in the gym component of that facility supervised by an aide or physical therapy assistant while their physical therapist treats one or two other patients at the same time.
I do not have exercise machines nor a gym: I teach each patient how to properly correct their posture, eliminate or decrease the causative and perpetuating factors and perform the progressive exercise program at home with support of educational videos. If you do go to a gym, I will review your exercise program and recommend appropriate modifications.
Most of my patients present with more than one diagnosis and associated symptomatology (see conditions treated) that contribute to their chronic pain and dysfunction, have commonly not benefited from physical therapy at other facilities, and never received a comprehensive initial evaluation nor treatment that was specifically geared to the actual causation and ongoing perpetuation of their entire symptom complex.
All of the above necessitates the need to perform an extensive initial three-hour evaluation to delineate all the factors to be addressed within each individualized treatment paradigm, that culminates in a self-typed 6+ page report that is not computer-generated. Click here to see an example.
Please note that every evaluation and treatment is 100% performed by me as I do not have any aides or assistants that participate in your treatment. Each treatment is comprised of the two most important components - my head and my hands - based upon 58 years of experience backed by publications, teaching and research. The addition of any adjunctive modalities is included and does not increase the fee/visit.
It is also important to understand that insurance companies pay in-network physical therapists the exact same treatment fee regardless of the patient’s problems/diagnoses. In addition, recent graduates without any clinical experience are paid the same amount per treatment as those with extensive experience, post-graduate continuing education, and specialty certification, which I have.
Therefore, I highly recommend that you contact your insurance company prior to your appointment to determine if you have a deductible that must be met before they will reimburse for treatment and ask if you have out-of-network coverage and what the specifics are. If they require “pre-authorization approval” such as a script from your dentist or physician, I will need to obtain this prior to the date of your first visit.
Click here to see the fee schedule.