If you’ve been looking into pelvic floor therapy you may have noticed a trend: most of them are out-of-network. And the ones who aren’t have SUPER long waitlists.

So do you wait on the really long waitlist or do you put up the money and pay for the out-of-network clinic to get started sooner? Well, the answer is a little more involved than a yes or no. Let’s dive into the four areas that make out-of-network clinics the best choice for many!

First, to set the tone for this whole blog post, I started my career in a private practice that accepted insurance. When I moved to Maryland I worked for a large company who accepted insurance. There are great therapists who work at companies who accept insurance. Typically the issue isn’t the therapist, it is the restrictions placed on them by the insurance companies or the big bosses to be able to make enough money for the company to run. So this is not at all meant as a way to bash on those therapists - they are doing their best! And that isn’t to say that patients who need to go in-network to use their insurance cannot get good care. What it does mean is that patients going in-network need to be aware and advocate for their needs as best as they can or make an informed decision around what to expect with an in-network vs out-of-network clinic. *Steps off soap box*

So like I said in the beginning this can be broken down into four parts:

1. Expertise
2. Care
3. Service
4. Cost
   

Expertise

As a specialty pelvic floor practice, our clinicians have advanced training in all areas of pelvic floor therapy. After obtaining our degree and our clinical license, we continue on to take countless continuing education courses in our niche to be able to provide expert care to our patients. 

This is in opposition to other physical therapists and occupational therapists who treat a variety of patient populations with some pelvic floor diagnoses sprinkled into their day. At this frequency, these providers have likely taken 1-2 basic classes to get the gist of what to do. We find this leaves too much room for generalization and not enough knowledge to dive deeply into the symptoms’ root causes. At Pelvic Pride we work with patients who have pelvic floor diagnoses or issues all day, every day!

Due to this advanced and continued training, our hands have become incredibly skilled at treating and assessing pelvic floor related symptoms. As in most of the therapy world, our hands are our tools and we use them with each patient. The inverse of this is the common

experience at an in-network clinic where a patient may be left in a room hooked up to a biofeedback machine or with a dilator inserted while their therapist is elsewhere in the clinic working with another patient. (I mean they have to get those billable units somehow - it’s a vicious cycle!)

We pride ourselves on our strong manual therapy treatment methods and our ability to incorporate this in the clinic along with a supportive home exercise program designed to continue the success we are having during our treatment sessions. 

Care

If you’ve been to a traditional outpatient orthopedic clinic then you are no stranger to working with rehab techs or aides along with your physical or occupational therapist. This is how clinics are able to see so many patients throughout the day. 

At Pelvic Pride you will spend your entire appointment working one-on-one with your pelvic floor therapist. This means every exercise or hands-on technique is performed by your highly educated and skilled clinician. You can ask questions and will get expert answers in return. 

To top it off, all of our appointments are performed in private treatment rooms so you don’t have to worry about discussing your pelvic pain, urinary leakage, or pointing to your pubic symphysis pain in front of a crowded gym. I mean we are all for body empowerment and normalizing talking about our symptoms, however we respect that socially that is not the norm. Our patients appreciate the ability to share all of the details without an audience.

Service

Convenience and availability are two key components of service and we strive to make sure we hit the mark on both of these. Our Patient Care Coordinator plays an active role in managing our clinicians’ schedules to ensure no appointment space goes unfilled. We regularly use our waitlist to guarantee that any patient who wishes to be seen can be accommodated as soon as possible in the time slots that best fit their schedule. By doing this, we are able to offer same week, and oftentimes same day appointments to our new patients. 

Meanwhile with the in-network clinics you end up sitting on a waitlist, which is the worst! Especially when you’ve been dealing with your symptoms for a while, are desperately looking for answers, or have a time sensitive matter like a pregnancy. Just imagine a wait list so long that you deliver your baby before ever being seen for your pregnancy concern. The convenience of same-week appointments is one of the main reasons people choose to seek care from an out-of-network clinic. 

Not only do we want to have enough appointment slots available to you, we also want to have our time available to you. To do this we offer 75-minute long evaluation appointments and 60-minute long follow up appointments. By offering longer appointments we find you have plenty of time to fully share your story and it allows us the time we need to examine every aspect as we get to the root cause of your symptoms. We find this just isn’t possible when clinics are scheduling new patients every 30 minutes. That is hardly enough time to share your story, let alone ask questions too. 

The final point of service to highlight here at Pelvic Pride is our inclusive care. While many clinics boast a ‘Women’s Health Program’ or treatment for pregnant moms, new mamas, or women of all ages; we treat EVERY patient with a pelvis. (This means everyone!!) Our patient caseload is generally evenly spaced along the gender spectrum with a specialty program for trans patients seeking care for Gender Affirming Care.

Cost

We recognize that this is likely concern #1 for most people - and we get it! It is important that you are making an informed decision when spending your money. At Pelvic Pride we have transparent pricing which we are happy to discuss when you reach out to inquire about our services. This means no surprise billing at the end of your treatment time with us. 

Unfortunately this is not the case with in-network clinics due to the way they work with insurance. While there are a lot of intricacies to this, the big takeaway is that if your insurance benefits are maxed out in the middle of a month (like with a 35 visit limit for PT/OT) but the clinic you are at bills insurance monthly, they may not be alerted that your insurance coverage has been maxed out and you are now on the hook for the cost of care for half a month. 

As a reminder for many insurance plans, you will also need to meet your deductible before your coverage starts. This means you are paying out-of-pocket towards your deductible before you switch to your copay or coinsurance. In Maryland, the average out-of-pocket deductible is $1600, which is then followed by an average of $30-$90 copay.

This is why we encourage patients who are concerned about their insurance benefits to ask about their deductible, including if their out-of-network care will go towards their deductible or if they have out-of-network benefits to reimburse the cost of services. 

Finally, and this is one of the best parts, your plan of care is based solely on your needs and not dictated by insurance. As discussed above, many insurance plans have a visit limit per calendar year or they will place a limit on the number of visits they approve based on the patient’s diagnosis. At an out-of-network clinic, we are able to decide on a plan of care frequency that best fits your current symptoms and your ultimate goal without being told by insurance that they no longer wish to cover your care. This means you are the top priority at Pelvic Pride, not the insurance plan. 

In Review

It is important that you are truly informed when making a decision between an in-network and out-of-network clinic and can see the whole picture of the pros and cons of each. The decision of where to seek care is a personal choice and is not to be made lightly. We hope this information is helpful and provides you with some better background information and the tools you need when deciding on a location for care and advocating for the care you deserve. (Read this blog post to see a list of questions to ask each clinic as you choose the right one for you)