Out of Network
It’s a question we get a lot. And sadly, the answer is no. The question here: Do you take my insurance?
I’ve written quite a bit trying to get ideas out on paper to describe, maybe to myself, why Cali Performance is cash based. With all of this I truly believe it comes down to control. While the ability to accept cash instead of an insurance contracted rate places the business of Cali Performance in more of a position of control, the real shift is in giving the athlete control of their health.
Let’s walk through a typical insurance based scenario. You hurt your shoulder trying to improve your health via CrossFit. A quick phone call to your family physician turns into a moment of despair finding out the next available appointment isn’t for another 3 weeks. Do you skip workouts for those 3 weeks? Can you at least talk to a doc about it real quick? Is there anyone available other than some dude on Instagram showing off his abs talking about the 3 best exercises for shoulder pain?
Finally, your appointment arrives. Your MD walks in, talks about your weight and blood pressure then asks what’s going on with your shoulder. When you mention CrossFit he rolls his eyes and tells you to be careful. There’s nothing he can do for you today without an MRI so he tells you to schedule with reception on your way out and walks out to go see his next patient. Talking to reception you find out the imaging center has an opening in 4 weeks. Seriously, WTF!
You’re trying to improve your health with CrossFit and every “Health Professional” doesn’t have any options for you… or at least not anything quicker than a 3-4 week time frame. At least all you paid for the two visits was your copay, Right?
With Cali Performance’s cash based practice we’re able to give you control back. Imagine what you could accomplish with physical therapy in 7 weeks. We’re not here to tell you to wait around on imaging. We’re not here to tell you what insurance will or won’t cover. We’re here to help you keep working out.
Let’s contrast our process with the all too common scenario above. You hurt your shoulder trying to improve your health via CrossFit. You reach out to Cali Performance for an appointment because Dr. Matt coaches some of your classes. After setting up an appointment during your typical workout time on a day next week. You feel a sense of accomplishment because Dr. Matt has helped a few people at the gym already.
During your appointment you are able to talk about how your shoulder feels and what movements are limited during your CrossFit workouts. After some massage and cupping your shoulder is feeling better and Dr. Matt walks you through a few exercises as he explains what’s going on at your shoulder and what all you can do to help. Not only did you get treatment by a healthcare provider in less time than it would have taken to see your MD you are able to follow up two more times! Each of these times you get hands on care and exercise progressions that really help you feel better about moving heavier loads overhead during your CrossFit class - something Dr. Matt encouraged you to keep doing and gave you modifications for various movements that were painful.
This doesn’t happen in the insurance world. This level of education on how you can continue to be in control of your health as well as timeline. I know you might be thinking to yourself, but Cali Performance could do all of that and take my insurance too couldn’t they? The sad answer is no. Most insurances want prior authorization before PT. This might be an MD visit or at least a call to the insurance to verify. In that case you’re back to the original timeline of waiting for your MD visit. Insurance also doesn’t know what to do with people who take control of their health themselves. They’ll approve medications and imaging all day. But are skeptical of exercise and education regarding sleep and nutrition - meaning Cali Performance could bill for some of those services but may not get reimbursed.
Getting back to the point. It’s a sad story of people getting lost in the insurance authorization process and waiting for visits or imaging when you try to use your “good insurance”. Our main objective at Cali Performance is to get you back to movements Rx, and that means you need to be in control of the process. Bring insurance into the mix and you won’t even have that option. Or at least not for long.
