Let’s talk about insurance.
I am an out of network provider. I do not contract with any insurance companies, and patients pay me directly at the time of service. In turn I provide them with a “superbill” which they can submit to their insurance to be reimbursed directly.
Here is why I chose this route:
I have never liked people telling me what to do without good reason. Ask my parents, teachers, and past bosses and they’ll tell you this is true. Some might call it stubborn, but I consider it self-advocacy.
When I started my practice, I had to decide if I wanted to take insurance or not. The first question a prospective patient asks is “Do you take my insurance?” If I answer yes, I have removed one barrier. However, taking insurance often creates more barriers:
-Many insurances require a referral for PT, which means one more appointment to make and get to, adding an unnecessary barrier. Most of my patients are busy moms—it’s enough to ask them to make an appointment with ME, where they’ll actually get some help! Having a visit simply to get a referral does nothing to actually help an individual, and the runaround often is enough to make a gal give up seeking the help she needs.
-Some limit the number of visits they’ll cover based on algorithms instead of your unique person and situation. It’s fairly common to see insurance approve “6 visits in 3 weeks.” This is fine for an ankle sprain, but for someone dealing with incontinence or painful sex for a decade, it really just doesn’t cut it.
-Some won’t pay until you hit your deductible, which can be upwards of $5,000. I’ve had patients complete several visits before getting a bill in the mail, only to realize none of it was being covered because they hadn’t met their deductible.
-They all require an absurd amount of administrative time for the provider. As a one-woman show, I believe my time is time better spent on providing excellent patient care. It’s what I’m good at. And really, that’s what you are paying for.
Like I said, I don’t like other people telling me what to do, and I don’t want anyone telling me how to treat my patients. Ultimately, I believe this relationship is between you and me, and a third party shouldn’t be telling me how much I can treat you or how much your care is worth. I work for you, not your insurance. I want you to know the value of what you are paying for, no surprises.
Our healthcare system is broken—I don’t have to tell you that. It is too broken for one person to come along and fix it. I believe we all need to be our own self-advocates. The first step to doing that is to understand the coverage that you have individually. Often, it’s not as comfortable as we thought it was.
I encourage all of you to know your coverage. Don’t know where to start? Here is a list of questions to ask your insurance company. Keep asking questions until you REALLY understand your coverage. Keep advocating for yourself and your family.