Pinnacle Physical Therapy is an out-of-network (OON) clinic, designed with the patient’s needs in mind. Delivery of care is provided in a private and distraction-free environment. Appointments are scheduled 1:1 without patient overlap to optimize efficiency of treatment progression as well as patient privacy. 

In-network providers have agreed to accept a discounted rate for providing their service in exchange for being listed as a preferred provider by an insurance network. This carries serious ramifications for how services can be supplied to the consumer. One result involves decreased time with the provider. Providers are forced into carrying a high volume case-load with the help of assistants and aides to keep the business open. In-network providers are subject to what seems like annual percentage decreases in payment which does not make sense in a world where inflation has been consistently on the rise. To add insult to injury, there are networks that constantly change billing rules, thus forcing therapists to spend their time and energy on keeping-up with the ever changing regulations rather than on actual patient care. One way insurance companies drive how the patient is treated is by assigning a lower dollar value on select billing codes to discourage their use. This is not considered an “evidenced based practice” but effectively undermines the therapist by devaluing their clinical judgment. In-network reimbursement rates make it impossible to balance running a profitable practice while still providing quality patient care.

When a provider moves Out-of-Network (OON), they are choosing to take third-party groups out of the equation when it comes to making treatment decisions for their patients. They believe that these decisions should remain strictly between the patient and the provider. Complex problems are best handled in a low patient to therapist ratio environment. One-on-one care is foundational for building the most effective and efficient treatment program to meet the patient’s needs. At Pinnacle, we believe that providing quality care is non-negotiable.

Yes. Most insurance companies will provide payment for services received “out-of-network”. Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out-of-network in order to see the physical therapist of their choice. The end goal of documentation and billing remains the same.

As an out-of-network provider:

• An upfront fee of $300 will be required prior to each initial evaluation.

• An upfront fee of $200 will be required prior to each follow-up visit.

We will submit claims to your insurance company on your behalf. Any reimbursement will be made directly to you based on your out-of-network benefits.

Physical therapy is a direct access profession in the state of California. This means that a patient may initiate care under a physical therapist without a doctor’s referral. If your insurance is covering all or a percentage of your physical therapy visits, you may receive treatment without a signed plan of care from your physician for up to 45 calendar days or 12 visits, whichever comes first. If your course of care extends past this timeframe, a signed plan of care is necessary.

Bear in mind, not all insurance plans are created equal – some still require a referral/prescription from a doctor or other referral source (Physician’s Assistant, Nurse Practitioner, Podiatrist, Dentist, etc.). It is never a bad idea to see your doctor before initiation of care to ensure that this is the best path for you to take. Patient care is at its best when a team approach is used. Communication is maintained with your referring physician or the physician you indicate on your intake paperwork through sending the evaluation and progress reports to them.