In-Network vs. Out-of-Network

What is In-Network?

• When a doctor or facility accepts your health insurance plan and is a verified provider, they’re considered
  in-network.
• In general, you pay out of pocket costs until you hit your deductible, and then your insurance plan benefits
  kick in.
• You may be denied services or treatment if the insurance company deems the treatment “not medically necessary.”
• Treatment may be delayed due to the insurance provider’s back up in paperwork.

What is Out-of-Network?

• If a doctor or facility has no contract with your health plan, they’re considered out-of-network.
• You are not forced to follow a model where the insurance company dictates the kind of treatment you are allowed
  to receive.
• A common misconception is that out-of-network will automatically cost more money. When looked at in the context
  of overall treatment: Primary doctor visits, Specialty doctor visits, Physical therapy visits, Pain Management
  visits, etc. out-of-network could actually save you significant money.

At Maverick Manual Therapy & Performance, we insist on being a strictly “Out of Network” provider. We believe that ouryears of specialty training override the ever-changing restrictions and mandates of most healthcare plans. YOU are ouronly concern. We make sure you receive highly individualized treatment and therapy without hindrance and delays frominsurance and healthcare policies.

In-Network Forced Practices

We are seeing an alarming trend with in-network practices for therapy services.

• Only a specific allotment of treatments are allowed, regardless of whether your rehabilitation is complete.
• Increases in treatment denial.
• Decreases in reimbursements for therapy services.

• Clinics are having to put in place cost-saving and increased billing practices, such as:

  • Limited time with the doctor.
  • Exercises and movement overseen by an assistant and not the doctor.
  • Therapists working with multiple patients during the same session.
  • Multiple diagnostics and treatments performed at every visit for billing purposes (ultrasound, e-stim, etc.)

Maverick Manual Therapy & Performance Practices

We believe that quality of care and one-on-one time is a worthy investment in your body. Your quality of life should notbe dictated by your insurance provider, nor reliant on any specific healthcare professional. By being out-of-network,Dr. Labus can work to find the root cause of your pain, and provide proper treatment for your specific condition.

• He spends more time with each patient, which leads to less overall appointments needed.
• We do not use clinical support staff to oversee visits.
• We develop individualized treatments based on your needs, there aren’t any “one-size-fits-all” programs.
• If 2-3 treatments are all that is needed, we won’t drag you back for 4-6 treatments.
• If we are not seeing the anticipated response to treatment, we’ll revise our approach or discuss collaboration
  with other providers who might be able to provide additional information or intervention to meet your goals.

Author Maverick Manual Therapy