No surprises here. Insurance in America is broken. Kind of.
We have an amazing medical system that excels at saving your life. Did your aorta just rupture? Your best bet of survival is living in the US when it happens. However, we are terrible at preventing individuals from reaching the state at which their aorta could rupture. There's a reason for that.
The transportation, operations, procedures, monitoring, and hospital care required to save you from those life threatening events is incredibly costly. Therefore, insurance companies have to make up that cost of care somewhere else, i.e. preventative services such as physical therapy. There are obviously other major factors that apply here including American lifestyles, our food sources, and our attitudes about health. All of these factors are coming together to put a major strain on the insurance and health system.
I don't prescribe to the notion that all insurance companies and hospital systems are evil and only want to make a profit. There are certainly some changes that need to be made to the systems to encourage better competition, and there are certainly instances of egregious denials and cost cutting that effect patients directly, but on the whole, these companies and hospitals do want to treat their patients and make people healthier. They just happen to be running into major costs including soaring administrative cost as the systems become more complex.
If you ask any provider in the current insurance model system, they are going to tell their biggest headache is insurance and administration. Most of these providers simply want to treat, but are bogged down in the system as everyone tries to make the books balance. Given these strains on the healthcare system and provider's desire to just treat how they see fit and not worry about so much paperwork, many are opting for the out-of-network status.
Being out-of-network simply means these providers don't accept contracts with insurances. They are going to see you one on one for a longer period of time, write straightforward notes about your care, and then give you a bill that you can submit to your insurance. This enables these providers to focus on you, the patient. Their heads aren't buried in their laptops all day, they're not pushed to see more and more patients, and your paperwork isn't lost in a maze of administration and billing departments. This is where we want to be at Harbor Performance and Rehab.
The beauty is that in the long run, out-of-network providers can actually save you money. Seeing a Doctor of Physical Therapy once per month to work on personal training, acute rehab, or injury prevention can signifcantly lower your healthcare costs (and costs to the system) by keeping you healthier. At the same price as you would spend on your deductible throughout the year, you can have dedicated 1 on 1 sessions with your DPT every month to check up on you and tweak your exercise programming.
Out-of-network also means that we're not hampered by insurance on how we treat you. We don't have to request pre-authorization for just one body part for a set number of weeks. We can treat whatever concerns you have, whenever you have them, and treat them however often you want to, all without having to get a referral and bothering your primary care.
I won't pretend out-of-network is all roses and sunshine, though. Requiring up front payment is difficult for some patients, and there are those of whom out-of-network care would never be an option. That is where the responsiblity of pro-bono services comes into play. If we are stepping outside of the system to treat how we want, it is on us to then help those who are left behind after that move.
Overall, we are taking an approach that we believe will be better for our patients and community, as well as allow us to take a larger responsibility in tackling the healthcare issues in this country. We want to give people the tools and knowledge to be healthier, on their own terms. If this interests you, give us a call. If you already have, let me know your thoughts about this post next time I see you.
As always, we're here to get you moving.
Dr. Thomas Emiren
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