Are We Serving The Insurance Company Or The Patient?

Have you ever been to a healthcare provider (physician, physical therapist, nurse, etc.) and felt as though you didn’t get the time and attention you deserved?

Most people have!

Why is that so common throughout our healthcare system today? And why are many healthcare providers choosing to go out of network with insurance companies?

An out of network provider does not contract with insurance companies to accept certain negotiated rates. 

For the providers themselves, reimbursement rates from insurance companies are decreasing, leading to the demand for providers to see more patients in a shorter amount of time. This does not promote improved health care.

How could a provider give better, more effective care when they have to see more patients in a shorter period of time? This can only lead to patient misdiagnosis, prolonged recovery, and increased costs, as well as increased burnout rates for the healthcare providers themselves.

Patients are dealing with increased financial responsibility out of their own pockets as well. Co-payments are skyrocketing. There are increasing deductibles and decreasing percent of coverage. Patients are not only receiving lower quality of care but also having more financial burden!

Let’s take a look at the following example:

Patient A goes to a traditional physical therapist who is in network with their insurance company and covered at 80%. During each session, Patient A receives 10 minutes of one-on-one treatment from their physical therapist and is then handed off to an aide. This patient attends physical therapy 3 times per week for 6 weeks, for a total of 18 visits. The total one-on-one care equals three hours. With each visit costing $125 dollars with 80% coverage, the total cost out of the patient’s own pocket is $450.

Patient B goes to a nontraditional physical therapist, who is out of network with their insurance company and is covered at 50%. Patient B receives 60 minutes of one-on-one care from their physical therapist. This patient attends physical therapy 1 time per week for 4 weeks, for a total of 4 visits. The total one-on-one care equals 4 hours. With each visit costing $125 dollars with 50% coverage, the total cost out of the patient's own pocket is $250.

It is clear that Patient B spends less time at physical therapy, receives higher quality of care and spends less money out of their own pocket.

I had the opportunity to complete my clinical hours for my orthopedic residency at an out-of-network physical therapy clinic in Manhattan, NY, called KIMA: The Center for Physical Therapy and Wellness. KIMA promotes individual, personalized care, treating one patient every 45 minutes. It was there that I realized that patients can receive high-quality physical therapy services with them as the priority, not the insurance company

As an out-of-network physical therapy provider, I have the luxury to design treatment plans to address my patient’s needs, not the needs of the insurance company. I now have the time to to give patients my undivided attention that they deserve and give more effective care. Because of this, my patients get better and often faster results. I became a physical therapist to help people live better, healthier lives, and my physical therapy practice was established for the same reasons.