Insurance & Billing

in network vs out of network
Why We Choose to Be an
Out-Of-Network Provider

Why is Warrior Sports Physical Therapy an out-of-network clinic, and come to think of it, what is an out-of-network clinic? The short answer is that we are out-of-network because we wouldn’t be able to offer the level of service that you have come to expect from us, while working in-network with insurances.

Why is that? This is where things get complicated. When a provider signs on with an insurance company, the provider agrees to operate under that insurance company’s rules and regulations, and to do them for a discounted rate. These rules usually involve how many visits you, the patient, can receive in a year, or how frequently the insurance company will authorize visits during your plan of care.

That means that the insurance company, and not you, the patient or provider, decides how many treatments you will receive. It also means the insurance company decides when you are “all better” at which point you are no longer permitted to continue treatment. The insurance company decides what “all better” means. Usually, the company will determine that if you are pain free, have adequate strength, and could possibly continue some exercise on your own, then you are “all better”.

This unfortunately, doesn’t take into account what your goals as the patient are. If you would like to return to your sport 100% ready, run or weight train, or even get down onto the floor with your kids or grandkids, the insurance company doesn’t care and won’t pay for those services should they fall beyond what the company has already deemed as sufficient care.

Explore Our Products

This affects you negatively in many ways. First, treatments may be delayed as a result of the clinic needing to wait for authorization to start your treatment. Then there may be a limit on how many sessions you can attend prior to needing another authorization, or worse, the determination that no further treatments will be covered. On the other hand, remember that the provider agreed to a discounted rate with these insurance companies, so what if you were allowed nine authorized visits, but felt great after three or four? Well, most providers would try to create a reason for that person to finish the nine, because the company would want to get paid for those visits. This is obviously very wrong and, unfortunately, all too common in mainstream physical therapy clinics.

Now, what about the situation where you are training for your sport, a 5k or half marathon, or maybe a Spartan race, but an injury sets back your training? Well, according to an insurance company these personal goals are not “functional tasks” or “activities of daily living”, and because of that, the company won’t pay for your treatment to be able to do them. In the company’s eyes, if a person can walk pain free, that is all the insurance company should have to pay for. Now, if a provider or clinic agrees to the insurance company's contract, the provider also agrees to only provide treatment for its members if the therapy is deemed to be medically necessary. To us at Warrior Sports Physical Therapy, this simply makes no sense. A patient and his or her therapist are the ones who should be making that decision, and because of that we will never agree to insurance companies’ contract terms.

As a consumer this certainly can make your head spin. You pay for good health insurance, and feel that you should be able to use it. There are times at Warrior Sports Physical Therapy where we can bill your insurance as an out-of-network provider to help offset physical therapy costs.

These situations are totally plan dependent and can be tricky to understand, but if possible we promise to go the full length to save you as much money out of pocket as we can for the best care possible. We also are able to sign single case agreements for workers compensation and motor vehicle accident cases if proper case information is provided to us.

We make a conscious decision to not have set contracts with any insurance companies because they are not looking out for your health and wellbeing. They are looking out for their bottomline.

Thank you for selecting Warrior sports physical therapy as your physical therapy and sports rehabilitation provider! it is our mission to get you back to peak performance as quickly and safely as possible.

We appreciate that the cost of medical services can be difficult to understand, and it is our goal to make the billing process as easy and transparent as possible.

We accept all major insurances, including but not limited to:

  • BlueCross BlueShield (Highmark)
  • UPMC (OON)
  • Aetna (OON)
  • Cigna/ASH
  • United HealthCare
  • Medicare (OON)
  • Tricare and VA Community Care Program (OON)
  • Workers Comp
  • Auto Insurance
  • Self Pay Rates

Out of Network Benefits are always utilized when possible. For further billing inquiries, please contact us via email or phone call and we will be happy to assist you, to the best of our abilities, in determining what your therapy costs will be.

Warrior Sports Physical Therapy will submit insurance claims on your behalf. For plans with a deductible that has not been met, we will normally collect a minimum of $50 to apply towards your overall balance (deductible). This is NOT a single payment for that particular visit, but is applied to your overall Plan of Care. These payments help alleviate a large bill at the end of your service.

we hope this helps you understand our decision
For more information, please contact us below.

Get in touch

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.