INSURANCE
Medicare
Life Elevated Therapy is a participating Medicare provider. Our rehab program is designed to assist Medicare, insured and uninsured individuals with maximizing their ability to function independently following a neurologic, vestibular or traumatic events.
Why We Choose To Be Out-Of-Network
The short answer is that we are out-of-network because we wouldn’t be able to offer the level of service that you have come to expect from us, while working in-network; that is, under the insurance model. Why is that?
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When a provider signs on with an insurance company, the provider agrees to operate under that insurance company’s rules and regulations, and to do them for a discounted rate. These rules usually involve how many visits a patient can receive in a year, or how frequently the insurance company will authorize visits during a plan of care. That means that the insurance company, and not the patient or provider, decides how many treatments a person receives. It also means the insurance company decides when a patient is “all better” at which point the patient isn’t permitted to continue treatment. The insurance company decides what “all better” means. Usually, the company will determine that if a patent is pain free, has adequate strength, and could possibly continue some exercise on his or her own, the person is “all better”.
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This affects patients in many ways. First, treatments may be delayed as a result of the clinic needing to wait for authorization to start treatment. Then there may be a limit on how many sessions the patient can attend prior to needing another authorization, or worse, the determination that no further treatments will be covered.
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Know Your Costs Upfront
As we all know from past experience, the insurance run around can be confusing and challenging. After paying a co-payment, then getting an explanation of benefits, then getting a bill we are left wondering, “What am I actually paying here?” This unfortunately is how the system is run.
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One of the intangible benefits of paying for physical therapy services upfront is that you will know your exact costs. At an out-of-network practice there are no hidden fees or bills that will be sent after treatment is provided. What you pay at the time of service is all there is. In fact, you might even get money back from your insurance company if you submit the superbill from each visit. Wouldn’t it be nice to have your insurance company pay you for a change!
What is “Out-of-Network”
If a provider has stated that they are “out-of-network” for certain insurances then they have not negotiated any rates or payments with any insurance company. Attending an “out-of-network” physical therapy clinic means that you will be paying for services out of pocket. In most cases this payment amount is less than what an “in-network” clinic would charge your insurance company. After services are provided by an out-of-network physical therapist, they will provide you will a detailed bill, called a "superbill", that you can submit to your insurance company. This bill will tell the insurance company that you have paid for and received physical therapy care. Your specific insurance plan may have what is called “out-of-network benefits” in which case you may be reimbursed some or all of the monies paid. Check your insurance plan to find out if you have these benefits.
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Deductible
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Just like with an “in-network” provider, you still are required to meet your yearly deductible before your insurance company will pay for services. Your insurance may have different deductible amounts for in-network and out-of-network care. Once you have met your deductible for out-of-network therapy your insurance company will reimburse YOU based on the set rate.
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High Deductible Plans
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Many insurance plans now carry a high yearly deductible. As stated above, this number can run over 5,000 dollars. If you are in need of physical therapy services, and you have not had any other medical care in the current year, you will have to pay out of pocket for services until you meet your deductible. Each visit you attend at physical therapy will be paid for at the full rate until the deductible is met. Typical charges at an “in-network” physical therapy center run between $150-250 or more when paying the full amount. Certain carriers have specified out of pocket amounts that each client should pay and these usually run 50-100 dollars.
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Below is comparing "in-network" vs “out-of-network”scenarios.
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In-Network Clinic
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30 min one-on-one time with PT per session
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2 sessions per week
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$75-180 payment per session
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1 hour total time with PT
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$150-500+ total in payments
Out-of-Network Clinic
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60 min one-on-one with PT per session
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1 session per week
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$120 payment per treatment
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1 hour total with PT
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$120 total in payments
Average savings for out-of-network care
1-week average savings=$130
2-week average savings=$260
3-week average savings=$390
4-week average savings=$520
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From the above example you can see that for the same amount of one-on-one
treatment time with your physical therapist there is a 130-dollar savings per
month with out-of-network physical therapy.
In Conclusion
From the above examples you can see that for those with high deductible plans or higher co-payments for physical therapy, seeing an out-of-network therapist may save you time and money. Health insurance can be confusing and frustrating to manage but the Life Elevated Therapy team can help you navigate the process. Every insurance situation is different and the above examples are by no means comprehensive. Please consult your insurance provider to determine your exact benefits for out-of-network physical therapy.