Should You Go Out-of-Network?

Dwindling reimbursements, complicated insurance regulations and limited time with each patient– these are just some of the reasons why many physical therapists are seriously considering going out-of-network. Physical therapists, particularly those who have been practicing for some years, know the struggle of staying in-network. But would going out-of-network really be the best solution?

What Going Out-of-Network Really Means

Before making this decision, it’s important for therapists to understand fully what going out-of-network means, and what it entails. Essentially, going out-of-network means offering your services outside of any insurance network. Since there is no insurance to split the bill patient costs will be higher, which is why most patients will only opt for out-of-network services if they are no longer satisfied with what they are getting in traditional, high-volume treatment facilities.

Given this fact it is vital then, for out-of-network services to be of the highest quality. Because patients pay more for these services, they also expect more.

The Perks of Going Out

While patients may expect more, meeting and even exceeding their expectations is not really a problem in an out-of-network model. One of the perks of going out is that you are able to spend more time with each patient, screen them better, and overall give them a better and more personalized level of care. You are able to focus on each patient, and even have the time and energy to hone your skills in the process. You are also able to develop trust and long-term relationships with patients.

The other great thing about going out is that you are no longer bound to any one insurer, and therefore are not bound by the limits of reimbursement rates. You can, within reason, collect the full treatment rate from the patient.

So When Should You Decide to Go Out-of-Network?

These benefits may be reason enough to make that switch, but you need to consider other reasons as well. If you are no longer happy with the remuneration you are getting; if you feel you are not getting paid what is due; if you feel that reimbursement policies are becoming too restrictive; or if you are tired of contracted rates constantly changing, then going out-of-network may be the right move for you.

But even with these under consideration, there are still various other factors that can affect how successful or unsuccessful you may be operating in an out-of-network model. Factors such as location, local demographics, existing patients not having out-of-network benefits and others can all determine whether or not you can actually succeed within an out-of-network model. Because these factors can be incredibly varied from case to case, it is best to consult with experts regarding these matters.

When it comes to this point, medical billing companies are one of the best sources you can turn to for information and advice. They know the ins and outs of medical transactions, billing and insurance, and can guide you in making the best decision. However, you need to make sure that you choose a trusted and reputable billing company, one that has proven their credibility through years of operation and a solid portfolio of clients. Park Medical Billing is one such company.

If you’re thinking about going out-of-network but are uncertain of how it will affect your practice financially, feel free to give us a call at 201-585-7306. We would be happy to assist you in making the best decision for your private practice.

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