Skip to Content

An Out-of-Network Doctor Costs Less Than You Think

I have said this before and I will say it again, medical care is the one aspect of your life that you should not be frugal about. Having, said that I will also say that no one in their right mind likes to pay a lot of money on medical expenses. I’ve been seeing a physical therapist on again, off again since my unexpected medical problems began. He charges $128 a visit, which I have to pay out of pocket because he doesn’t accept any form of medical insurance.

So why do I visit an out-of-network therapist? The answer is a bit complicated. I complained of pain in my shoulders and neck for years. Every doctor I visited sent me off to a physical therapist to help ease my pain. Most of the therapists ignored me. They instructed me to perform exercises that made the pain worse. Most of them placed me on some type of equipment, set a timer for twenty minutes, and then walked away. During this time in my life I visited at least ten different therapists. Unfortunately, their procedures were all exactly the same. Set a timer. Walk away.

So when I ended up in the emergency room with a disorder that should have been caught years before hand, I wasn’t about to go back to any old physical therapist. Months later and after surgery, I nearly cried at the thought of starting physical therapy. Feeling as though the medical community had betrayed me, I started looking into various types of alternative therapies including massage therapy and acupuncture.

A co-worker recommended an acupuncturist who recommended a physical therapist who specializes in trigger point therapy. Trigger point therapy is a procedure in which therapists inject needles into ‘trigger points’, (painful, tight areas of the muscle), to break muscle spasms and pain. Not only does my therapist specialize in this area of expertise, he also listens to his patients. He spends a full hour listening to concerns and working one-on-one with me. No timers are set and he never walks away. The fact that he does not accept insurance is actually a blessing. It forces him to remain accountable to his patients. After all, if he doesn’t assist in our healing, we’ll simply take our dollars elsewhere.

In all due honesty, I would visit this therapist even if my insurance didn’t cover any of the cost. As I mentioned above, frugality has no place in medical care. Ask any sick person; they’ll tell you they’d give away every earthly possession to feel well again. But just for kicks I ran a cost of analysis of my treatments, and what I found astounded me.

My insurance currently pays 75% of the costs for visits to out-of-network providers. So for a $128 visit my insurance company will reimburse me $96. That means I end up with a bill for $32. $32 sounds like a lot of money for one visit to the physical therapist, but here’s the kicker: If I went to an in-network provider I would owe a $25 co-pay. Subtract that $25 from the $32 I pay out of pocket and the visit only costs me $7 more than visiting an in-network therapist. The peace of mind and trust in a good health care provider is certainly worth $7 more a visit.

One Frugal Girl

Thursday 25th of January 2007

Kim --- That is a great point, insurance coverage usually does require a deductible, and that deductible can be quite hefty. I've had so many health expenses that I usually blow through the deductible in no time. For those who rarely visit doctors the deductible could be a significant out of pocket expense.

Kim

Thursday 25th of January 2007

I'm about to see an out-of-network doctor, who specializes in alternative therapy, but i think it's worth mentioning that you have to meet the deductible for most insurances. For example, I must pay out-of-pocket $500, before my insurance starts kicking in 80% coverage (their rate for out-of-network providors). However, that first $500, if i spend it in a year, will be re-imbursed by my FSA. In short, get a FSA.