Understanding In‑Network vs Out‑of‑Network Care at Lotus Core PT
As you search for new providers, you may have heard the terms In‑Network and Out‑of‑Network used by your insurance company. Before we talk about how Lotus Core Physical Therapy works as an Out‑of‑Network, cash‑pay/fee‑for‑service clinic, let’s clarify some key health insurance terms.
Healthcare Insurance Terms:
In-network: A healthcare provider who has a contract with your health insurance plan to provide services at a pre‑negotiated (discounted) rate.
Out -of -network: A healthcare provider who does not have a contract with your health insurance plan; services are billed at the provider’s usual rate, and your costs may be higher or, in some plans, not covered at all.
Deductible: The total amount you agree to pay out of pocket for covered services each year before your insurance plan starts paying its share (this may apply differently to in‑network vs out‑of‑network care, depending on your plan).
Co-Pay: A fixed dollar amount you pay for a covered health care visit or service (for example, a flat fee for each PT visit). This usually applies at the time of service and may or may not count toward your deductible, depending on your plan.
Co-Insurance: A cost‑sharing percentage that starts after you’ve met your deductible (for example, 80/20, where the insurance company pays 80% and you pay 20% of the allowed amount). Some plans require you to meet your deductible before coinsurance applies.
Out of pocket maximum: The most you would pay in a plan year for covered services, including deductible, copays, and coinsurance; once you reach this maximum, your plan typically pays 100% of covered services for the rest of the year.
Out of pocket expenses: The money you personally pay for covered health care services (such as deductible, copays, and coinsurance) during the plan year; these payments are tracked toward your out‑of‑pocket maximum.
CPT codes: “Current Procedural Terminology” codes that identify the specific services or treatments you receive during a visit (for example, manual therapy, therapeutic exercise, or evaluation codes in physical therapy). You can view common PT CPT codes here: WebPT ’s guide to physical therapy CPT codes.
HSA (health savings account)/FSA(Flexible savings account) accounts: Tax‑advantaged accounts that allow you to use pre‑tax dollars to pay for eligible medical expenses, including physical therapy in most plans.
Cash pay/fee for service: A payment model where the provider is not billing your insurance directly and is not contracted as in‑network; you pay the clinic at the time of service, and you may use a superbill to seek reimbursement from your insurance if you have out‑of‑network benefits.
Why Lotus Core PT is Out-of-Network:
At Lotus Core Physical Therapy, we prioritize high‑quality, individualized care and have chosen not to contract with insurance companies, which means we operate as an Out‑of‑Network provider. Our cash‑pay/fee‑for‑service model allows us to provide traditional and advanced physical therapy services with:
Fewer restrictions on visit length, frequency, or body regions treated in a single session
More flexibility in treatment planning without needing insurance pre‑authorization or approval for specific CPT codes
The ability to focus on your goals, not on meeting insurance company productivity or billing requirements
This structure supports care that is guided by your presentation, evidence‑based practice, and clinical reasoning—not by insurance rules.
What You Can Expect at Lotus Core PT
At Lotus Core PT, you will find:
One‑on‑one, holistic care with appointments typically lasting 60-90 minutes.
A customized treatment plan without restrictions on which body areas can be addressed in a single visit, so we can treat the whole person.
A strong commitment to identifying and treating the root cause of your symptoms, not just the site of pain.
Real value placed on listening to your story and partnering with you as a teammate in your care.
Reimbursement and Superbills
If your insurance plan includes Out‑of‑Network benefits, you may be eligible for partial reimbursement when you see an Out‑of‑Network provider. At Lotus Core PT:
You pay at the time of service (cash, card, HSA/FSA, depending on your preference and plan rules).
We can provide a Superbill, which is a detailed, itemized receipt with all required information (CPT codes, diagnosis codes, provider information, and charges) for you to submit to your insurance company.
Your insurance company may apply these amounts toward your out‑of‑network deductible and, depending on your plan, may reimburse a portion of your costs directly to you.
We also offer a one‑page guide with questions you can use when calling your insurance company to compare potential costs and benefits of in‑network vs out‑of‑network care for your specific plan.We aim to advocate for you and guide you through your health journey—whether you are recovering from an injury, addressing pelvic health concerns, or working to prevent future problems.
To request this guide, email Info@lotuscorept.com with the subject line: “Insurance guide sheet.”
If you’re ready to pursue care at Lotus Core Physical Therapy, you can book an appointment at www.lotuscorept.com and start your health journey today.
