Why Out-of-Network Care?

I know. Insurance is boring. But, here is a question I have to address often so hear me out…

Why “In-Network” may not be the cost-effective approach to your baby’s therapy:

analysis blackboard board bubble

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Lil’ Peanuts Physical Therapy was founded with the goal of helping babies and parents when they need it most along with the belief that top-notch, high quality, one-on-one care cannot be rushed, limited, or capped. A child’s quality of life and growth should not be dictated by his insurance company.

Due to new changes in health insurance plans, high deductibles, and costly copays, sometimes just being “in-network” does not mean lower costs for services such as physical, occupational, and speech therapy.

Early intervention is most effective with frequent and consistent treatment sessions in a short amount of time while babies are drastically changing and growing the first few years of life.  These therapy sessions add up. Having to wait months for insurance approval, reimbursement, and referral to in-network therapists, means critical periods of infant development are missed and care time ultimately lengthened, adding even more to total cost for services.   Not to mention, wouldn’t you want to choose who you go to for therapy (based on specialty and experience) rather than wait for insurance approval?


full frame shot of eye

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Insurance providers and adjusters are notorious in their tactics to pay as little as possible on claims:  often denying charges, limiting diagnosis codes, delaying payments, and requesting re-evaluations every few visits.  Some may even put limits on the frequency of therapy regardless of how well the baby is progressing.  The entire claims process itself can take months to sort through. This means that instead of just concentrating on providing the most effective evidence-based interventions, a therapist has to spend therapy time every couple visits to run tests on the child and submit proof for why he would benefit from a higher frequency therapy than the once monthly allotted by insurance.

Once again, critical growth and developmental milestones are missed during all this tug and pull with insurance companies: a child who could have fully improved after 8 weekly sessions may end up needing a year of monthly sessions to complete her therapy goals. In baby development, timing, intensity, and frequency of therapy is critical.  I have seen insurance companies deny coverage of consistent therapy for children with diagnoses such as torticollis, cerebral palsy, and spina bifida, which are all well-researched diagnoses.  The benefit of early and frequent physical therapy is well-documented in the scientific community for these conditions!

topless toddler with pants sitting on white surface while looking up

Photo by Henley Design Studio on Pexels.com

There has been a recent shift in U.S. healthcare and even primary care providers and medical specialists are making the move to fee-for-service clinics. Private-pay clinics are actually great for therapists AND patients.  Read more here about why the question really should not be ‘Will my insurance cover this?’ but ‘Whom can I trust to give me and my family the best care for my money?’

About PT4Peanuts

Judy is the proud owner of Lil' Peanuts Physical Therapy, P.C. She is a board certified pediatric specialist who has worked with children all across the country, from NICUs to outpatient day rehabilitation centers. She is an avid blogger and full proponent of APTA’s 2020 vision for physical therapy. Her passions lie in educating children, parents, teachers, clinicians, and future therapists so that they can best reach their full potential.
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