What does out of network mean?



Today’s health care field is a very complicated and changing landscape. As a patient we know that it can be daunting to look at your costs and options while still trying to receive the absolute best care for you and your loved ones.

At Impact Physical Therapy our entire business model was set up with the patient’s best economic and health interest in mind. Before you ask how that can be at a much higher up front cost let me explain several of the perks and truths about “out of network” physical therapy.

First and foremost let us talk about the most valuable asset of our business model, time. Each and every person that walks through our door gets 1 hour of 100% undivided attention from a highly trained doctor of physical therapy.

During this time our sole purpose is to give you a great and meaningful experience. This low stress set up for our Doctors allows them to fully and uniquely assess and treat their patients. At no time are they rushed to cover multiple patients, do paperwork, or pass you off to another staff member. Time being the most valuable commodity we made sure to dedicate it all to you.

Second, we must highlight our staff and the use of educated dynamic treatment. Our goal is always to provide a customized and individualized treatment approach. Our staff’s large collection of post graduate training allows them to employ a wide array of tools to help you. Our staff is well versed in multiple hands on techniques including; Functional dry needling, Myofascial release, Mulligan MWM, and cupping.

Outside of passive techniques our staff is comprised of multiple CSCS, certified strength and conditioning specialist as accredited by the NSCA. This means not only are you able to receive hands on pain relief, but also get counseling on movement correction and specific programming tailored to your  individual capabilities and needs.

Now how does this actually affect the bottom line of increased cost you might ask. Well, we have two really exciting answers to help make this an economical endeavor for our patients.

First, by dedicating our time and skill set solely to you, as opposed to multiple patients as commonly seen in other clinics. We are able to reduce the total amount of visits for most of our patients.

As co-pays and deductibles continue to rise this can be a huge defining factor! It is not uncommon to see $75 co-pays and deductibles as high as $5,000. Most people are having to pay out of pocket for physical therapy… 

If you are going to pay out of pocket, you should choose a provider that will take the time to listen, and get you back to life in less sessions. 

Example: Out of Network vs. In Network 

Out of Network Traditional “In Network” PT
Cost Per Visit $150 Co-Pay $50
Number of Visits 4 Number of Visits 12
Total Costs $600 Total Cost $600
Time Spent with the PT 240 Minutes Time Spent with the PT (15 per 30 minute visit) 180
Cost per minute $2.50 Cost per minute $3.33

In addition many insurances have out of network coverage. What this means is that our staff can provide you with a “superbill” which you can then turn over to your insurance for a percentage of reimbursement, which directly lowers the cost of treatment

Different states insurances have varying out of network benefits.Each insurance has a network of providers that they use at a discount. We are not a part of this group BUT this does not mean your insurance won’t help.

For example we have had BCBS patients receive up to 80% reimbursement bringing your cost per session to $33.  Aetna has also had reimbursements of 40-60%. Our staff is more than happy to help assist you with finding out these specific figures and instruct you in how to submit a superbill for these benefits.

Every bit of the Impact model is centered on the patient. From getting you appointments quickly, spending every minute with you, to helping reduce the overall cost of your treatment. We are 100% on your side and hope to help you soon!

Check out this great video:

About Dr. Eric Hefferon

Dr. Eric Hefferon received his advanced doctorate degree in physical therapy from the innovative A.T. Still University. He has been practicing in the west valley for 6 years and has made strong ties to local gyms and medical practitioners. Dr. Hefferon started Impact Physical Therapy due to his passion for an individualized healthcare approach. He knew by creating a clinic that was out of network he could help give patients the results they deserve. His treatment style attracts patients from all over the valley and even out of state. People will travel to seek Dr. Hefferon’s solutions!

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