When a patient comes to a physical therapist after years of persistent pain, they put all their trust in us. They share their grief about not being able to enjoy their child’s homecoming due to ongoing pain, their anger with their bodies because no matter how many surgeries they’ve had, medications they’ve taken, therapies they’ve attended, or how hard they’ve worked, they are still hurting. Patients express their frustration with medical providers who continue to dismiss them. When our patients share their deepest vulnerabilities and shame with us, it is imperative that we listen.
As an in-network practitioner, large healthcare companies and insurance agencies determined the care I could provide. I was slammed with the expectation to see 2-3 patients per hour. Needless to say, when my patients were sharing their traumas, I wasn’t able to truly listen. I had to move on to the next patient whose exercise was finished and who was waiting for the next round. My mind was constantly jumping from one patient to another. There was no time to LISTEN, which is a foundational tool for any therapy.
Insurance companies also determined the therapy I could provide and for how long. I remember one patient who was dealing with back pain. She had been to many providers over the years, had a laminectomy, but nothing had worked. When I evaluated her, we discovered she was also dealing with pelvic organ prolapse. “Aha! No wonder you are still having back pain that ‘core strengthening’ hasn’t helped,” I thought.
I explained to her how the pelvic floor could be a contributor to her back pain and we made a plan to work on pelvic floor rehabilitation. It wasn’t long before my insurance claim got denied because the code I used for “pelvic health” was deemed unnecessary for treatment. I had another patient with chronic pelvic pain and testicular pain, but I could only see him for 4 visits because the insurance wouldn’t authorize more.
I was burnt out. The requirement to see around 13 patients a day to keep the business running (because insurance reimbursement rates are so low and continue to decrease) combined with mounting documentation (much of it pleading with insurance companies to authorize more visits) left little room for joy in my life. This also meant there was little room for joy in my work—specifically, the joy of learning.
Being an out-of-network provider has allowed me to invest my energy in evidence-based courses, to read journals, and to stay current with the latest research on pain management. I can now email my patients’ other providers to share updates and collaborate with other providers who are doing great work. All of these things help improve patient outcomes.
As an out-of-network provider, I now see patients on my terms. I am no longer forced to see patients at least twice a week by an external authority. I am more present during my sessions. I continually update my knowledge. I can provide hands-on treatment as necessary. I am able to communicate more effectively with my patients and their providers. And, most importantly, I am a much happier person and a much better therapist!
We also also did some maths. When patients are coming in 2-3 a week in an in-network facility to just do their exercises, they end up paying almost the same amount as a copay. As an out of network provider, because I am able to give more time, follow-up more effectively, patients achieve great outcomes in a fewer number of visits.
I write all this with the understanding that not everyone can afford out-of-network care, particularly individuals from low-income or minority communities. That’s why in my practice, I offer sliding scale prices for those in need. I also strive to provide as much free educational content as possible through workshops.