Mend Physical Therapy Blog and Injury Information

Is Out-of-Network Physical Therapy More Expensive Than In-Network Physical Therapy?

January 18, 2021

out of network physical therapy-in network physical therapy

For the vast majority of Americans, the health insurance game has changed a lot from the days of employer supported plans with low deductibles and $20 copayments. The cost of healthcare is increasingly being placed upon consumers so it may benefit you financially to consider the following factors when choosing a Physical Therapist.

  1. Out-of-network care can actually save money. Many consumers mistakenly think that if a physical therapy “does not take” their insurance (ie: is an out-of-network provider), it will cost more. Recent research shows that cash-based or out-of-network physical therapy practice actually saves consumers money over a course of treatment. 

    • By the numbers: Pulford et al (2019) reported $780 total cost for out-of-network care (mean 8 visits) versus $936 for in-network care (mean 7.3 visits), a savings of $156 associated with out-of-network care. 

  2. You typically must meet your deductible before your benefits kick in. If you have a high deductible plan and you are relatively healthy, you may NEVER meet your yearly deductible thus making your insurance “benefit” less beneficial. You’ll need to shop around for the most cost-effective care as you’ll be paying out of pocket. 

    • By the numbers: Out-of-network care 4 visits, duration 1 hour = $490 out of pocket, in-network 8 visits, duration 30 minutes care = $600-800

  3. The cost of physical therapy varies widely based on the type of facility in which you receive care. If you elect to receive physical therapy in a physician-owned physical therapy practice (POPTS) or hospital-affiliated system they can bill at rates much higher than a private practice owned by a Physical Therapist. Recent data shows that the cost of physical therapy at a POPTS is 35% higher than at a clinic owned by a physical therapist. If you are responsible for the out-of-pocket cost until your deductible is met (see #2), you can be hit with a costly bill you may not have expected. At MEND our rates are transparent and you pay up front so you’ll never be caught with a surprise expense. 

    • By the numbers: Out-of-network physical therapy evaluation $130, in-network physical therapy evaluation $200-300+ (if POPTS or hospital) .

  4. What is your copayment and how much 1:1 time are you getting with your physical therapist versus staff without a professional degree? At MEND, your care will be provided exclusively by a board-certified or fellowship-trained Doctor of Physical Therapy, we do not utilize clinical support staff. Advanced training and expertise allows us to find the root cause of your problem and get on the path to solving it right away.

    • By the numbers: Out-of-network physical therapy: 4 visits = 4 hours 1:1 with your physical therapist = $480, in-network physical therapy: 4 visits = 2hours 1:1 time with your physical therapist = $200 ($50 copayment) -OR- 8 visits = 4 hours 1:1 time with your physical therapist = $400 ($50 copayment)

  5. How many visits do you expect your care to take? We strive to make significant progress towards your goals within 3 visits for most diagnoses, an average course of treatment at MEND is in the neighborhood of 6 total visits. If we are not seeing the anticipated response to treatment, we revise our approach or discuss collaboration with other providers who might be able to provide additional information or intervention to meet your goals.

    • By the numbers: Out-of-network: 4-6 visits over 6-12 weeks = $490-730, in-network: 2 visits per week for 6-12 weeks: $600-$1200 ($50 copay) 

Please contact us with any questions you might have about care at MEND. You can always book a free consultation here if you’d like to experience our practice first hand.