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  • Danyell Russell, PT, DPT

What does “Out of Network Provider” mean? And why would you want to see one?

Strong Foundation Physical Therapy is an Out of Network (OON) provider, but what does that mean? It means that we do not contract with any insurance companies and do not take medical insurance for our services. Wait, that doesn’t sound like a good thing, now does it? Let me tell you why we don’t take insurance and why it is actually a good thing.

Reimbursement from insurance companies for physical therapy services is on a steady decline, which is not just a problem for physical therapy providers, but also for our patients. With reimbursement declining, physical therapists have to find ways to make money somehow, which often leads to seeing a high number of patients per hour, double or triple booking appointments, using modalities to fill appointment times, and use of support staff to provide physical therapy services. This dilutes the quality of care that our patients are receiving and results in extended durations of PT. With an OON provider like Strong Foundation PT, you will spend the entire session one-on-one with your physical therapist where they are able to correct form, be hands on throughout the process, and make minor and major adjustments for your plan of care. You will get the quality of care that you deserve and your therapist will be 100% focused on you, your goals, the things you love to do, and getting you back to those things.

In addition to reimbursement rates decreasing, the amount that the patient is responsible for is also increasing. It is not uncommon for a patient to be responsible for a high deductible and then once that is met, for them to have an out of pocket maximum that is unlikely to be met. Often times, this means that patients are paying more out of pocket for these in-network benefits than they would with an OON provider. As discussed previously, you would be receiving excellent care from an OON provider like Strong Foundation PT, which often times results in fewer sessions being required and improved results with resolution of symptoms and return to function. Fewer sessions required means less financial burden for you, the patient. So in essence, you could actually PAY LESS for BETTER QUALITY of care.

Many OON providers also have specialized niches that they primarily treat and have focused their education and training for treating that specific population, which means that you can rest assured that you really are getting the best quality of care for YOU. Strong Foundation Physical Therapy specializes in the CrossFit and weightlifting athlete. Our Doctor of Physical Therapy, Danyell Russell, is a CrossFit athlete and has focused much of her training in assessing and treating this population. She has a Certification in Clinical Management of the Fitness Athlete (Cert-CMFA) from the Institute of Clinical Excellence, which has proven itself paramount for treating these athletes. She has taken additional training in management of the pregnant and post partum athlete (CMFA Pregnancy and Post Partum). She also is Level 2 Certified in Functional Dry Needling, which is an effective treatment tool for musculoskeletal issues. So if you are a weightlifter, CrossFit athlete, a pregnant woman, or new mom just wanting to get back into the gym, rest assured that Strong Foundation Physical Therapy will provide you the very best quality of care to help you attain your goals.

In summary, an OON provider does not accept insurance because they want to provide you the absolute best quality care that you can receive. Receiving care from an OON provider may not actually be as expensive in the long run as going to an in-network provider and you may actually spend LESS money with an OON provider. You also can guarantee that you are getting care that is specialized for your needs by seeing an OON provider that specializes in your sport or population. So no, Strong Foundation Physical Therapy does not accept your insurance, but we think that it is actually a GOOD thing that we do not.

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