In Network vs Out of Network

In network vs out of network is a dilemma for many. I am an Out of Network physician as opposed to in network for a number of reasons. I would like to share them with you so that you all can make an informed decision about your own healthcare.

First and foremost you need to call your insurance company and ask them for your chiropractic benefits. This is the easiest thing to do and yes they will tell you the information may change the next time you call. (More then likely it will not but they do not want to be liable). Once you get the information of your plan for in network vs out of network chiropractors you will have the information to make an informed decision as to what will be more beneficial for you.

Remember that you will have a deductible to meet and once that is met, then you will have your co-pay. Chiropractors are still categorized as a “specialist” unless otherwise told. This is usually a different fee than your Primary Care doctor.

In Network Vs Out of Network:  What is In Network?

If you are going to go with a doctor that accepts your health insurance they are referred to as In-network. What this means is they signed up to “accept” that insurance. This is an application process that everyone must go through. When the doctor’s office signs up, they are given a fee schedule for all of the different services that the health insurance will reimburse them for.

The insurance company will then be allowed to dictate how many visits you are allowed to have. This does not matter if you are fully better or not. Also, most insurance companies lump chiropractic, physical therapy and occupational therapy all together for allotted visits. So make sure you watch out for that as well.

In Network Vs Out of Network:  What is Out of Network?

If you go to an out-of-network doctor, most of the time there will be a flat fee for services. This makes life much easier than having to look up patients’ insurance information to see what their specific co-payment is. The reason I decided to have the fees I do is because I wanted to make it affordable for people to come in. Therefore, my flat fees have typically been lower than what the co-payments are today.

With having a flat fee and not accepting insurance, I am able to decide what care is in the best interest for each individual patient. I do not need to jump through hoops to get a service paid for if they do not allow it. For example if you have an acute injury and your low back is in spasm I will use electronic stimulation and ice on you. If your insurance company does not accept that as a service, then you will not be getting that service even though it would be beneficial to you. I do not agree with that logic so therefore I do not participate. I give my patients the care they need.

There is no deductible that needs to be met. You are more than welcome to get a super bill and submit those into your insurance company to have the amount go towards your out-of-network deductible. This can be down at any time as well. This can be done at any time as well. So if you have a large deductible and you know you will never meet it, then submitting the super bill may not be beneficial to you. But, if something happens and you ended up using a good amount of the deductible, then submitting the charges you have already paid will help you meet it sooner.

In Network Vs Out of Network:  Conclusion

  • Do your research first and see if using your insurance is the best option. Yes, I know you are already paying for the insurance and want to use it, but if it is cheaper for you to go out of network, don’t be afraid to do that!
  • Choose a doctor you like and trust, not just one that is conveniently in your network. You can always switch if it is not a good fit.
  • Out-of-network; there is a flat fee for services and most of the time it is the same or cheaper.
  • If you have a deductible you can submit your visits to get them counted/reimbursed.
  • Which is the best option considering in network vs out of network?:  Depends on you.