Many people hear the term out-of-network and just assume it is not the right option for them. Or that out-of-network means it will cost more. But what you may not realize is opting for this route can save time and money.

All too often people do not actually read though all of what is on their insurance benefit sheet. Deductible, Co-pays, Coinsurance…what does all this mean? We just assume insurance will cover (______). But in truth that is hardly the reality.

In today’s present state, health insurance is there for the WORST of times. Insurance will hopefully prevent you from getting hit with a $200K hospital stay bill. That is after you paid the large deductible and out-of-pocket max. It is no longer built or administrated to take care of all the small stuff….

You know, those visits to see your doctor for 5 minutes, your regular check-up at say the dermatologist (because you are looking to be proactive with your skin), or even addressing those aches or pains that are slowing you down. Those aches that we ignore until they are much larger and cause more trouble in daily life. The problems that if dealt with early on, are much more easily treated. AND will cost less.

So, how can seeing that out-of-network physical therapist save time and money?

Well… How much time does the average person spend with their physical therapist in a regular outpatient clinic? About 15 minutes on average per session. The rest of time is spent with support personal. Plus on average a person will have about 12 sessions 3x/wk for 4 wks) for any given condition. All for the low low copay price of $25-50. Now multiply that by  2 or 3 sessions per week and you spent $50-150 per week to see your therapist for 45 minutes. Oh, and don’t forget about that deductible. Because that $1000-5,ooo (or more) gets paid over and above that copy (and before insurance will pay a dime). You just don’t see that bill for about a month (which could run as high at $200/session).

Based on these numbers you will be looking at a minimum of $1300-1800 in direct costs for a typical out-patient course of care (not including the deductible which co-pays do not count towards).

Next, lets now add up (the indirect costs) the time spent driving to therapy, at the session, and then drive home. We can ballpark this at about 2 hours per session times 3 and you are looking at 6 hours per week. Also add in the cost of not being at work or with the family. What is that worth to you?

Now, how does that compare to a typical out-of-network experience?

Most clinics that operate in that fashion tend to focus on quality over quantity. This means more time spent with the therapist. This also means for even just 1- 1 hour visit per week you may be able to accomplish as much or more than 3 sessions in another outpatient facility. But how is that possible….3 is more than 1? True, but by having that 1- 60 minute session, you can have the full attention of the therapist to learn about your condition and tweak your program to maximize the benefits. Not only that, but they have more time to educate you about just how you are going to create better carry-over between sessions with the home program. The average plan of care in this model will be 8-10 visits.

So, if we do the same math as above (at say a per visit rate of $150) we would be looking at $1200-1500 or $1800 if we said 12 visits. So the direct costs upfront is nearly the same BUT there is no further deductible hanging out. Plus, there is the added benefit of gaining back nearly 4 hours in your week. How valuable could those 4 hours be to you at work or spent with your family?

When you do the math, it just doesn’t compare. However, for some reason people still feel compelled to see that “in-network” therapist.

When it comes to our health, we all want the best…and at the lowest cost…because after all we paid for our “health” insurance. But remember cheaper is not synonymous with better or a better experience. Most are willing to pay to stay at that 4 or 5 Star hotel over a 2 star. Or prefer to drive a luxury car and eat at fancy restaurants over alternatives. The same should be done for one’s health.

For further information on how this concept of care can benefit you, please reach out to me at andrew@zangpt.com or fill out this quick Inquiry Form.