“Why Don’t You Just Bill Insurance?”
Shift Physical Therapy and Wellness is an out-of-network physical therapy clinic which means that we do not bill insurance companies directly for any services provided. This was a choice we made with INTENTION. Considering that we had previously worked in clinics where most sessions were billed to insurance companies, this was a big change, but truthfully it was not a difficult decision. Choosing to be out-of-network provides freedom to focus on the whole person in front of us during our session.
Often during insurance based sessions, you may be limited to treating one area of the body at a time. Anything that may appear to be unrelated to the original diagnosis can be denied coverage by the insurance company. Let’s give you an example: the patient is referred to physical therapy for right knee pain - during a session the therapist determines that the patient has a history of a surgery to the great toe on that leg which is limiting their motion of the foot while walking and causing pain at the knee. The therapist spends time improving mobility of the great toe and bills the insurance company, who promptly denies the payment because the therapist was “working on the foot” instead of the knee. As long as the therapist has documented the direct link between the limitation of the toe and effect on the knee, it is *possible* that they will be able to appeal the insurance company’s decision to deny payment for the session - but as you can imagine this is a lengthy process with a lot of hours put into waiting on hold to talk to the insurance company and sending documentation back and forth to get everything sorted out before the therapist will ever get payment for that session.
In addition to the hours of time waiting to talk to someone and get documentation sent back and forth, insurance companies continue to progressively de-value the service of physical therapy. Each year, a new fee schedule is released and often decreases the amount that will be reimbursed for each item billed to the insurance company. By continuously lowering their reimbursement, it forces insurance based physical therapists to try to make up the lost revenue by increasing the quantity of patients they are seeing. Often this is done through shortening treatment times (maybe seeing patients every 30 minutes instead of every 45 minutes or hour), overlapping patient care (double-booking), or hiring aides rather than appropriately trained physical therapists and physical therapist assistants to provide care to patients.
Insurance companies also have the ability to deny coverage based on certain diagnoses. For example, some insurance companies choose to exclude coverage for women with a diagnosis of dyspareunia - that is the fancy term for pain with sex. So, you’re telling me that insurance will cover Viagra for men so they can enjoy a healthy sexual experience throughout their life, but won’t cover physical therapy to help a woman who is experiencing pain during sex….hmmm…..
We have been asked several times since Shift Physical Therapy opened, “why don’t you just bill insurance?” Or “when do you think you will start accepting insurance?” The answer simply, we chose to be out-of-network to focus on the QUALITY of care of the WHOLE PERSON in front of us, so we will continue to remain out-of-network. While we could certainly increase the quantity of patients we see by moving in-network, it doesn’t make sense for the type of clinic we have designed and the kind of care we choose to provide to our patients.
Our patients always have the option to utilize health savings accounts (HSA) or flexible spending account (FSA) dollars that might be part of their insurance benefits. We also can provide the patient with documentation from each session to submit to their insurance company if they choose to attempt to be reimbursed directly by their insurance company. Each insurance company and policy has its own requirements for this, so it is important for you to reach out individually to your insurance company to discuss what this would look like for your situation.
We are always happy to discuss what your care at Shift Physical Therapy will look like, or answer questions for you about why we don’t bill insurance. We are also willing to provide resources to local insurance based physical therapists to those who wish to go that route. Do what works best for you, and we will always be here to support you in whatever way we can!
Written by: Renee Hancock, Pelvic Floor Specialist, Physical Therapist, Co-Owner of SHIFT
