Out-of-Network Reimbursement

What does cash based or private pay mean?

Cash based, private pay, or pay-for-service, simply means I am not in-network with any insurance plan, I am an out-of-network provider. Only out-of-pocket payments — Cash, Checks, Credit Cards are accepted forms of payment. But majority of health insurances do have out-of-network benefits (see below).

Why would you choose cash based over insurance?

Movement by Logan is a combination of physical therapy, fitness and performance training. Health insurance companies have a hold on your health care and cap the amount that they will spend on you, regardless if you need it or not. They also dictate where you can go to be treated. Physical therapy clinics that accept insurance, have poor reimbursements, so to make money they have to have a high client turnover. This leads to having several clients at once, a ratio of clients to physical therapists at 3:1, 4:1, 5:1, etc. It is impossible to pay attention to everyone at the same time and provide the same quality of care as 1:1. You are most likely paying co-payments and deductibles, as well. Movement by Logan is 1:1.

You will have exceptional care with all attention on you for the full session, unless you choose to participate in a group type setting (no more than 2-3 people at once). A one hour session with Movement by Logan will be worth a minimum of 3 visits at another clinic. Since there are no limitations with care, we can address more than 1 body part at once, as well as work on your overall fitness and performance level. Health insurance companies never pay for fitness and performance training.

Movement by Logan offers care that physical therapy clinics who accept health insurance just cannot provide. The care at Movement by Logan is provided by a Doctor of Physical Therapy, who is an expert in movement of the body. Your fitness and performance training will also be provided by the same DPT, which means it will be above the others. No gym or performance center offers the same expertise, experience, education, and skills Movement by Logan has to offer.

Out-of-Network Reimbursement Opportunities

With Movement by Logan, you will have the opportunity to get reimbursed by your health insurance company. Some health insurance companies will cover ‘out-of-network’ costs and may reimburse a percentage of your care at Movement by Logan. At the end of each session, if requested, you will be provided with the necessary paperwork to provide the insurance company. It is the responsibility of the client to call their insurance company to find out the benefits. 50-60% reimbursement seems to be most common, but this varies vastly.

When you call your health insurance company ask 3 Questions:
1. Do I have out-of-network benefits
2. Do I have a deductible? (some times there are in and out-of-network deductibles)
You may be able to use payments for Movement by Logan to help meet the deductible.
3. If you have a deductible, and that is met, what do I get reimbursed? (Reimbursement rate)

This will provide you with the information you need to know your out-of-network benefits, how much you are able to get reimbursed, and what you need to do to get the reimbursement.