November 16, 2011

Out of Network?

Black Diamond Physical Therapy contracts with every and any insurance company that we can, but there are several companies with closed or exclusionary panels.  We continue to try to break those barriers to contracting, but, unfortunately, there remain many patients left with out of network (non-preferred) coverage at Black Diamond PT. Before assuming you are out of network, contact us and you may find that we actually ARE a preferred provider.

Many patients are concerned that they will be paying more out of their pocket by going to an out-of-network provider.  Although when comparing visit to visit this may be true, when comparing the total cost of your physical therapy care it may not be.

At Black Diamond Physical Therapy, we take a focused and evidence-based approach to rehabilitation.  Our greatest goal is to teach the patient how to manage their care themselves.  That means educating you on what is wrong and the most direct way to fix it.  This ultimately results in fewer necessary visits over the course of your care not to mention an overall reduction in the total cost to healthcare.  Consider the following example (assuming $100 per visit to keep it simple):

In-Network PT Clinic                                  
20% coinsurance
2 visits per week x 4 weeks = 8 visits
Total cost of care:  $800
Total out of pocket cost: $160
Black Diamond PT (Out of Network)
40% coinsurance
1 visit per week x 4 weeks = 4 visits
Total cost of care:  $400
Total out of pocket cost: $160

The out of pocket cost is the same.  But let’s assume that you need a second month of care:

In-Network PT Clinic                                  
20% coinsurance
2 visits per week x 4 weeks = 8 add’l visits
Add’l cost of care:  $800
Add’l out of pocket cost: $160
Total cost of care: $1600
Total out of pocket cost: $320
Black Diamond PT (Out of Network)
40% coinsurance
1 every 2 weeks x 4 weeks = 2 add’l visits
Add’l cost of care:  $200
Add’l out of pocket cost: $80
Total cost of care: $480
Total out of pocket cost: $240

Less money out of your pocket and a little more than 1/4 of the overall cost to the healthcare system.  And that is assuming that you would even need that second month at Black Diamond Physical Therapy!

But my physician put “2x/wk x 6wks” on my referral.  Doesn’t that mean I HAVE to be seen that often?
No.  Most of the time that referral simply authorizes up to that many visits.  After you are evaluated we will educate you on what is going on and then, with your input, develop a treatment plan that is right for you and your goals.  We will then send a report to your physician with our recommendations for your their review and approval (if needed).

What if I have no insurance or my insurance will not pay for services at Black Diamond Physical Therapy?
We will always welcome patients who would like to take charge of their own care.  For patients paying directly for services at the time of their visit, we will extend a flat rate discount on the cost of their care. As with every patient, we do everything we can to keep the cost down and still get maximal results. We also have special programs for people who are unable to pay for their medical services. Contact us for more information.

For more information regarding our clinic philosophy or billing policies or to discuss your situation specifically, give us a call at (503) 288-4643.

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