WHY I DON’T BILL INSURANCE DIRECTLY.
The fee-for-service model is employed at Arrow Physical therapy because it ultimately allows me to provide the highest quality one-to-one care. No aides or assistants are used and you will receive thoughtful, personally tailored, excellent care.
Reimbursement for physical therapy is sub-par at this time and there are many regulations associated with using health insurance. It is the goal at Arrow Physical Therapy to spend more time with each patient, less time on paperwork, and to treat patients the way that is best and appropriate. This model will often lead to fewer visits needed and saves time and money in the long-term.
PATRON: Wow, that meal was incredible!!
CHEF: Good. I am so glad you enjoyed it. In fact, I specifically prepared it for you. I took into account your flavor pallet, your food sensitivities, and your average activity level in order make sure it was perfectly paired and customized for you. Keep eating meals like that and you should see results!
PATRON: Thanks. That’s so great of you and I can really tell that you care about my nutritional needs.
CHEF: I most certainly do. So, please enjoy yourselves and no hurry, but the bill will be $150.00.
PATRON: Oh sure. You can send me the bill.
CHEF: Sounds good. I will send it out. You can just return the payment in about 8 weeks. Additionally, if you don't agree that the value of the meal is $150, you can just pay me a portion of that...
PATRON: [Interrupts] Wait…. really? That seems odd…. I mean I was treated so well and I’m extremely satisfied… you should be paid your fee. And 8 weeks…?
CHEF: Well …
PATRON: [Interrupts again] I have been to other restaurants and the service is terrible, the food is terrible and I am never fully pleased.
CHEF: Well, this is how its done these days. In fact, if in the end, you don’t think that you NEEDED the meal (you weren’t actually hungry, you had already met your macros for the day, you hadn’t worked out, etc). you can deny the meal and not pay anything. But, you already ate it so it won’t affect you. It’ll just affect my business … and my ability to help others.
PATRON: Wait what?
CHEF: Yes, unfortunately, that is happening more and more at other establishments and should it start happening more frequently at this restaurant, I will have to start using less skilled and less expensive assistance as well as cheaper (less healthy) ingredients. And you’ll have to eat the meal in your car – not here – because I won’t be able to afford rent or light or heat.
Seems like a pretty unrealistic scenario for a business, right? Wrong. This is the exact model that physical therapists are facing in today’s healthcare world. The reimbursement culture we live in right now is leaving physical therapists with 2 choices.
1) accept health insurance from their patients but suffer the consequences:
- A requirement for “pre-approval” to deliver service to a patient (in order to determine if it is medically necessary)
- Increased paperwork requirements for payment
- Less compensation from payors for the same service
- Delayed or denied payment for services already delivered
- Shortening appointments so as to see more patients
- Using care extenders (aides or assistants) to deliver care
- Double booking (seeing more than one patient at a time)
- Using modalities such as electrical stimulation which have limited evidence to support their use but can be billed for (so as to be able to start working with another patient during the first patient’s session)
2) work in a fee-for-service model where they do not bill health insurance directly
I hope this sheds light on my decision to be an “out-of-network” provider. Not only, was the model effecting my business but I was getting denials to be able to treat CrossFit patients as their conditions were often not deemed “medically necessary” (ie. your insurance plan does not find it medically necessary when pull ups or ring muscle-ups cause your shoulder pain but you can still sleep and work at your desk without pain). I was also in a situation of having to format my schedule with patients in a way that they insurance model preferred. Often insurance will allow say 12 visits in a span of 6 weeks. Well, I see patients who need a different model. Most of my clients need appointments about 1x/week or once every few weeks, but I need to see them for maybe 16 weeks. Change takes time.
So, moving my practice out of network is my way to continue to deliver the care I believe is best and most effective. I refuse to let our healthcare system get in the way of your health and fitness goals. Seeing you 6 times in 3 weeks is not always more effective than 4 times in 12 weeks. A patient's plan of care needs to be individually tailored and not dictated by the insurance plan you have.
That said, I understand that a lot of folks in Seattle have great health care benefits and want to use these. I respect that and will happily refer you to my colleagues who are still working their hardest in the above insurance model. No hard feelings. But, I do think I a full understanding of your condition and rehab needs is useful and you should know that I philosophically believe that this is the right thing for my patients. I care about getting YOU better, not satisfying your insurance company’s requirements to help you improve to what they believe is “good enough”.
In most cases, you are not going to be 100% responsible for this bill. Often there is a separate out-of-network deductible and once met, most insurance companies will reimburse a percentage of the money you pay me. I will give you all the information you need to facilitate this process. Additionally, if applicable, you may also use your Flexible Spending or Heath Savings Account. If this model is financially limiting for you, please contact me directly at firstname.lastname@example.org.
Please see my payment page on the website for more useful tips and info!!