The place to find holistic information about your health

Why See an Out-of-Network Provider

Why See an Out-of-Network Provider

So, you need to see a doctor. The first step in doing something (anything at all) is seeing the need for it in the first place. Then you can make the necessary steps needed to get there.

Now what? The first question you probably ask yourself is “where can I go that accepts my insurance?” This is a totally valid thing! Maybe you have benefits through your job, or you are paying your hard-earned money each month for a coverage plan that works for you.

Oftentimes we make decisions solely off of the idea that we are saving money. It’s smart, it’s understandable, it is valid financially and conservatively.

Though, when it comes to our health, it may be more advantageous to ask ourselves, “where can I go that is best for ME.”

What is an Out-of-Network Provider

If you are like me, you find insurance to be confusing! So many different plans, options, coverage details. Maybe you are thinking what exactly does it mean to be an out-of-network provider?

In short, an out-of-network provider is not contracted with your insurance company. They do not have set fee schedules. This is unlike an in-network provider who has a contract with the insurance company to accept that company’s discounted pricing.

But that doesn’t mean that seeing an out-of-network provider will cost you a fortune. Some health insurance plans do have benefits that cover out-of-network provider costs. Therefore, it is important to get all of the information based on what your specific plan covers. You may have a deductible with either an in-network or out-of-network provider, so get all of the details before you decide!

How do you know if a provider is Out-of-Network?

You will be able to look up providers that are contracted with your plan either online or over the phone. If a provider is not listed, that usually means they are not in-network with your specific plan. You can always contact the provider directly and they can tell you if they participate with your plan.

Some insurance plans do have out-of-network benefits – meaning they will reimburse you a “reasonable and customary rate” for your visit. Keep in mind, your insurance decides what that customary rate is, and it may not always match up with what the out-of-network provider charges. It’s important to do your homework about what your benefits include, to avoid potential fees later.

While you are doing your homework, don’t forget the reason behind it – what you are actually going to see the doctor for.

Why see an Out-of-Network Provider

When it comes to seeing a doctor the most important thing should be: is it the right fit for you. When looking for someone ask these questions…

Do they treat what is going on with me?

Sounds simple, but it’s an important question. Do your research! Does the doctor you are seeing often treat the condition you have? Or maybe you are looking for someone that can diagnose your pain. Is it the right spot for you? And if you’re unsure, call and ask. Take control of your health and make sure you aren’t wasting your time.

Do they offer a wide range of services?

Essentially: what tools are in their toolbox. This is an important thing to consider. Maybe you have tried a variety of treatments and are looking for something different. Maybe you want to go to someone that specializes in something that’s worked for you in the past, or maybe you are looking for a specific service you know of or want to know more of. When possible, finding the right treatment should be prioritized over the right insurance coverage.

What is the approach that they take: holistic, specialized, broad?

If the provider you see is primarily concerned with the volume of patients – it is often harder to take a holistic view of the body and treatment will tend to be pain-specific. As out of network providers, in the clinic, our initial visit is an hour-long because we include a thorough examination of the functional movement of the body. This includes a postural exam, gait assessment, selective functional movement screens, orthopedic tests and neurokinetic therapy. The approach of the office can be important as well in terms of treatment time. Is it mainly passive or active care? A focus on active care means more homework and less time in the office – cost-efficient for you.

Time Effective + Cost Effective

In-network providers get paid a set fee schedule per treatment. So typically, they benefit more from a high-volume practice – meaning seeing more patients in a shorter time. This could mean quicker therapies to increase the number of patients they see and make more money (to pay rent, staff, operating costs, etc). The important thing is not compromising the quality of treatment.

An initial visit with an in-network-provider is typically 30 minutes, and follow-ups 5-10 minutes tops. As out-of-network providers, our initial visit is an hour and follow-ups 30-45 minutes. A thorough exam helps to find the root cause of the problem, treatment can then be targeted so that fewer visits are needed to get results!

More time with a provider could meantime for a more thorough exam, more services in one treatment session and ultimately faster healing and recovery time. In this way, seeing an out-of-network provider can be cost-effective in the long run, if recovery time is more like 4-6 visits than 20 visits.

Customized Treatment

At Urban Wellness Clinic we take pride in the amount of time we spend customizing treatment for our patients. Our initial visit is an hour long and includes a thorough evaluation, specific diagnosis, treatment that may include a variety of different services and exercises tailored to fit your needs that makes the transition from passive to active care quicker. Essentially, we want to give you the tools to fix yourself (so in the long run, you don’t need us!).

We prioritize continuing education. We want to be the ultimate best at what we do, so that we can serve our patients in the highest. That means expanding our skillset and always continuing to learn and grow. We consistently attend seminars and extra training; learning new techniques and therapies to better help our patients. Sometimes those techniques are not covered by insurances.

Specific therapies we utilize:

  • Active Release Technique – the gold standard in soft tissue therapy that can help restore normal function to affected areas as well as break up scar tissue and adhesions
  • Neurokinetic Therapy (NKT) – a diagnostic tool we use to help find compensations in the body that may be causing pain and dysfunction
  • Dynamic Neuormuscular Stabilization (DNS) – a rehabilitation technique that helps neurodevelopmental repatterning of the muscular and nervous systems just as we developed as babies. Its focus is on proper movement with joint centration and positioning.

Case Study

A patient recently came in with back and leg pain. She had a history of a disc herniation. She was going to a chiropractor for about a month where she would just get adjustments. Her visits averaged about 5 minutes. She noticed little improvement and after a recent flare up from sitting on a plane for many hours, these 5-minute adjustments weren’t helping her leg pain at all. We used Neurokinetic Therapy Testing to find which muscles were weak and which were overworking. After tracing the specific nerve root down the leg contributing to the pain, Active Release Technique was used to treat the tight muscles supplied by that nerve. After one visit she felt better, was able to walk without pain and had little pain in the leg. Four visits and her lower back was feeling better. A large part of treatment consisted of education and active care. So that even seeing an out-of-network provider, she saved money with fewer appointments necessary to see results and get pain-free.

These are just a few of the techniques that make us unique. When finding a provider, it’s important to look for someone that matches your unique needs. So, don’t count out an Out-of-Network Provider!

If you want to know more about us, your coverage or our insurance options, call us at 212-355-0445 or email us at Find what’s right for you.


Dr. Adriana Lazare, DC