• Melissa White, OTR/L, CES, FNS

Out of Network: High-Quality Care & Surprisingly Affordable

Here at Balanced Fitness & Health, we want to offer physical therapy treatment the way therapy was intended to be provided. The current system of health insurance forces you to accept many compromises in your plan of care. Our physical therapy clinic is Out of Network, but we take pride in offering uncompromising quality, delivered in fewer visits, and for less cost per minute.

There are three main differences between insurance-based providers in your network and our cash-based clinic related to time, attentiveness and cost.

1. How Many Visits?

Do you really need physical therapy 3 times per week for 8 weeks? Maybe not. We will work with you to develop a plan that will help you recover effectively while keeping in mind schedule and financial concerns. When you are receiving care in network, the insurance provider chooses how many treatments you get and also decides when you are “all better.” They do not take into account your goals or unique situations.

2. One-on-One Attention

Another advantage of working with a physical therapist who is Out of Network or cash pay is that you receive longer visits spent one-on-one with you and you alone. We will not treat other patients during your visit. Longer sessions allow more individualized time, which means you need fewer visits to reach desired results. This equates to overall healthcare savings, and it saves you time and gas money, too.

There is no secret handbook or cookbook given in school that tells us how to treat a specific diagnosis. Treatment should be customized, taking into consideration an individual’s activities, lifestyle, home and work demands, and even emotions related to the injury or pain. No google search can help to treat each individual or take into account all of these variables. We take the time to get to know you so we can integrate your overall wellness into the plan of care.

3. Cost

Still concerned about the upfront cost? First, remember that the cost you pay can apply toward your deductible, which can be up to $5,000-$6,000 per year. You may be paying out of pocket anyway until it is met. You can still utilize HSA and FSA accounts to help cover the cost. Second, most physical therapists have to collect a copayment along with billing your insurance. The cost is $60 or $70 per treatment, which is not much different than seeing a therapist outside of network at $85 per regular visit. A third consideration is that you can submit your claim to your insurance, and they can reimburse you. This can help reduce your out of pocket costs while allowing you to still avoid paying high copays.

We’ve broken down the costs for your In-Network vs Out-of-Network physical therapy options. In the end, the out-of-pocket costs are less per minute, making them a much greater value considering the on-on-one nature of our Out-of-Network care.

Cost Analysis Example

Assuming a deductible of $3,000 and a copay of $25, here is a breakdown of the difference in cost between In-Network and Out-of-Network physical/occupational therapy. Watch as Caley Medinger, DPT, explains in this video and see corrected breakdown of our costs below.

In Network

  • 3 visits/week for 6 weeks—Only 15-20 minutes of one-on-one care per visit

  • Cash cost: $25 x 18 visits = $450

  • $450 + $500 (deductible) = $950

  • ​The above reflects the copay plus the extra dollar amount not covered by insurance that will be billed to you.

  • 20 minutes of one-on-one time per visit = $2.64 per minute

Out of Network

  • 6 visits at 60 minutes each

  • Cash cost: $150 (initial) + 5 x $85 = $575* (NOTE: Video example shows $135 for initial visits. It is $150 for the first visit. This does not make a significant different in the cost savings.)

  • 100% one-on-one time = $1.60 per minute

*Rates subject to change.

The numbers speak volumes—you get more quality time for a lower cost per minute when you choose Balanced Fitness & Health, an Out-of-Network provider. In addition to affordability of our care, Balanced Fitness & Health recently received a 100% satisfaction rating for our work rehabilitation services, which verifies the quality of our care.

Completing the Forms is Easy! The out of network forms are easy to complete. Here is a copy of the member claim form from one of the area's leading insurance providers. We will provide you with all of the info you need to complete your insurance provider's form so you can be reimbursed appropriately.

If you’d like to learn more, read our initial post about cash-based care and contact us to get started.

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2200 Heritage Green Dr 

Hiawatha, IA 52233


Tel: 319-693-7745

Fax: 319-378-6951

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