Navigating Healthcare: Exploring the Meaning and Impact of an Out-of-Network Provider
As you search for new providers, you may have heard the terms In-Network and Out- of- Network providers that you can use through your insurance. Let’s explore some key terms before we dive into what an Out-of -Network or Cash Pay/Fee for service that Lotus Core PT is focused on.
Healthcare Insurance Terms:
In-network: A healthcare provider has contracted with the insurance companies for a pre-negotiated rate.
Out -of -network: A healthcare provider that does not have a contract with insurance companies.
Deductible: The amount you agree to pay with an in-network or out-of-network provider before your insurance plan starts paying.
Co-Pay: A fixed amount that you pay for a covered health care service. This cost can vary based on the type of visit. You typically pay this before to your deductible is met.
Co-Insurance: Presented as a percentage of your cost and the cost your insurance is paying (i.e 80/20 – Insurance company pays 80%, you pay 20%). At times, you have to reach your deductible before your co-insurance kicks in.
Out of pocket expenses: The amount of money you spend prior to meeting your deductible and is tracked for a calendar year.
CPT codes: These are identifiers for the services provided for your treatment or session. Check out WebPT for common CPT codes for physical therapy.
HSA (health savings account)/FSA(Flexible savings account) accounts: Pre-taxed money to pay for eligible medical expenses.
Cash pay/fee for service: The healthcare provider has not contracted with insurance companies and have flexibility to help patients reach goals.
Lotus Core PT benefits of opting in as an out-of-network provider:
At Lotus Core Physical Therapy, we prioritize high-quality care and have chosen to opt out to contracting with insurance companies, making us an Out-of-Network Provider. The cash-pay or fee-for-service model allows the physical therapist to deliver traditional physical therapy care with fewer restrictions, longer visits times, and autonomy to meet the individual needs of the patient.
At Lotus Core PT, you will find:
One-on-one, holistic care with appointments times lasting 60-75 minutes.
Dedicated to providing you with customized treatment plans without restriction on which body part to treat
Commitment to finding the root of the problem
Value in listening to your story and working with you as a teammate to help reach your goals
We aim to be advocates to guide you through your health journey, weather you are recovering from an injury or trying to prevent one.
You may be eligible for reimbursement rates when seeing an Out-of-Network provider. A Superbill can be provided to submit to your insurance company for reimbursement. We can provide you with a one sheet guide when speaking with your insurance to see if an in-network provider or out-network provider is right for you.
Email Info@lotuscorept.com and put in the subject line: Insurance guide sheet
If you want to pursue being treated at Lotus Core Physical Therapy, book here and start your health journey today.
