Why Should I Go Out-of-Network?

We understand. Nothing causes a worse headache than trying to understand your health insurance. 

Premiums. Deductibles. Co-Pays. Co-Insurance. Out-of-Pocket Maximums. In-Network. Out-of-Network. The system is not meant to be understood. Even once you understand the what these terms mean and how they apply to your specific health insurance plan, you can still run into surprise denials of care and, even worse: surprise bills. 

So what is the difference between out-of-network and in-network care? "I pay monthly for this insurance, so why would I not use it?"

The Limitations of In-Network Care

In-network providers are constrained by insurance company policies that often compromise care. Patients and providers alike frequently encounter:

• Visit Limits and Denials: Insurance companies impose arbitrary visit limits or deny necessary treatments, hindering recovery. For example, a patient may need ongoing physical therapy sessions but find that insurance only covers a few visits, forcing them to either stop therapy prematurely or pay out of pocket.
• Goals That Are Not Yours: Insurers often set the goals that lead to your discharge, often disregarding individual needs and aspirations. Instead of focusing on personal health goals, insurance companies set minimal benchmarks, such as being able to perform basic daily activities, which don’t consider full recovery potential or desired quality of life.
• Delayed Payments and Surprise Bills: Providers often face delayed payments or surprise bills long after services are rendered, leaving patients financially burdened and confused. These unexpected costs can disrupt a patient’s financial stability and create barriers to necessary care.

All three of these insurance-driven issues occurred with a client of mine just last year. The kicker: he had coverage with a major insurance company, not a small company that was unable to handle the bill. This patient, who was recovering from surgery, was experiencing significant post-operative pain and aimed to return to tennis, an activity he loved. Despite setting clear goals in every note and claim filed, the insurance company insisted on discharging the patient simply because he could walk around his home without discomfort..

Months later, the patient received an $800 bill for treatments rendered up to the initial denial and during the appeals process. This scenario is all-to-common and highlights the frustrations and financial impacts patients face within in-network clinics.

The ALTR Performance Difference

At ALTR Performance & Physical Therapy, we’ve chosen a different path. By not directly contracting with insurance companies, we prioritize:

• Patient-Centered Care: Every treatment plan is tailored to individual goals and needs, not dictated by insurance protocols. This ensures that each patient receives the specific care required to achieve their personal health objectives.
• Transparency in Pricing: We provide clear, upfront pricing to avoid surprise bills and ensure financial transparency. This allows patients to plan and manage healthcare expenses without fear of unexpected costs.
• Focus on Outcomes: Our success stories speak volumes—patients achieve meaningful recoveries and return to their desired activities without insurance interference. We measure success by patient satisfaction and outcomes, not insurance company metrics.

Why Out-of-Network Is Gaining Popularity

The rise of out-of-network healthcare isn’t just a trend; it’s a dynamic movement toward patient empowerment and personalized care. By opting for an out-of-network provider, patients gain the freedom to make informed healthcare decisions that truly align with their best interests. This choice allows them to select providers based on exceptional care and personal compatibility, rather than being confined by restrictive insurance networks.

At ALTR Performance, the emphasis is on quality over quantity, ensuring each session is tailored to achieving the patient’s unique goals. This dedication to high-caliber care not only leads to better health outcomes but also significantly enhances patient satisfaction.

The freedom to choose healthcare that meets individual needs—without the stifling constraints of insurance companies—creates a more personalized and effective approach to well-being. At ALTR Performance & Physical Therapy, the focus is entirely on you, not on the bottom lines of insurance companies. Together, we are helping to reshape healthcare into a system that genuinely prioritizes patient needs and promotes vibrant, healthy living.

Take control of your healthcare! Book Your FREE 15-Minute Consultation to discover how going out-of-network can benefit you!