Why We Don’t Take Insurance, and How We Help You Get Paid Back

01 · Let’s Start Honestly

We hear you. This is frustrating.

Jacques Courseault, MD, CAQSM, FAAPMR · The Fascia Institute and Treatment Center®

Let’s start with the hard part. Some people are angry that we don’t take insurance. A few have told us so. We don’t brush that off.

You pay your premium every month. You may pay a lot. Then you get hurt, or you live with pain for years. You find a clinic that might finally help. And that clinic says it is out of network. That feels unfair. In many ways, it is unfair.

But the unfair part is not the care. It is the system that decides what care gets paid for. We did not build that system. We work around it every day, and so do our patients.

So this page is not a sales pitch. It is an honest look at three things:

• ·Why we can’t do what we do inside an insurance network.
• ·What your insurance may still pay you back, even when we are out of network.
• ·How we help you get that money back, and why we pay for that help ourselves.

02 · How It Should Work

Health insurance should work like car insurance.

Think about car insurance. You get in a wreck. The car is broken. You take it to a good body shop. The shop fixes it. The insurance company pays for the repair.

The insurance company does not tell the mechanic how many minutes to spend on your car. It does not say the shop can only fix one dent per visit. It does not make you try the cheapest fix three times first, and prove it failed, before it will pay for the right one.

The goal is simple. If it’s broken, fix it. Then pay for the fix.

Not every car is the same. Not every body is the same.

A good mechanic knows a minivan and a Ferrari are not fixed the same way. A Ferrari has a finer engine and tighter parts. It needs a mechanic who knows Ferraris. Nobody thinks that’s strange.

Bodies work the same way. And most of our patients have Ferrari bodies. Many are hypermobile, which means their joints move more than most people’s. Their connective tissue is built differently. It is not broken. It is a different design, often a high-performance one. But it needs someone who knows how that design works, and a standard, one-size plan often misses it.

Now picture this. You wreck your car. The wheel is bent. Your insurance company says, “Fixing the wheel is experimental. It’s not necessary.” Or it agrees to pay, but pays the mechanic less than the wheel costs. You would be furious. No shop could stay open that way.

That is what happens in health care every day.

Health insurance often does not work the way car insurance does. Plans pay by billing codes. Each code has a set price. Many plans decide how much time a visit is “worth.” Some treatments need approval ahead of time. Newer treatments may be labeled “experimental” and not paid for at all, even when they help.

We wish it were different. We think patients deserve a system where the question is “What will fix this?” and not “What will the plan cover?” Until that changes, we are doing what we can inside the system we have.

03 · Why We Are Out of Network

What we do doesn’t fit in a billing code.

Our approach has two steps. It is the same for pro athletes and for everyone else.

• ·Step one: find the actual pain generator. That means the exact tissue causing your pain. Not a body region. Not a guess.
• ·Step two: find the right tool, or tools, to fix it. Then use them in the right order.

Most people who come to us already had step one fail somewhere else. That is why step two never worked. You can’t pick the right tool if nobody found the target.

Doing step one well takes time. Our doctors do the ultrasound themselves. We watch the tissue move while you move. We press on the spot to see if it brings back your exact pain. That is hard to do in a short visit, and in-network visits are often short.

Time

Our first visits are long on purpose. We listen to your whole story. Network contracts often push clinics toward short visits, so they can see more people per day.

Tools

Treatments like Hydrofascia Release™, ProloBoost™, and prolotherapy are often not paid for by insurance. Many plans call them experimental or not covered. That’s true even at in-network clinics.

The doctor

Your doctor does the exam, the ultrasound, and the procedure. In many in-network models, much of that work is handed off to others to keep costs down.

If we joined insurance networks, we would have to cut visit times, drop treatments that insurance won’t pay for, and see more patients each hour. We would no longer be the clinic people travel to when nothing else has worked.

So we made a choice. We chose to protect the care. Then we looked for ways to protect your wallet, too.

04 · Same-Day Care

Why we treat you the same day, when we can.

Our goal is to get you better as quickly as possible, in the most complete way. For many patients, that means we find the problem and treat it at the same visit. You don’t wait weeks for a second trip. You don’t lose another day of work.

Back to the car. Imagine the mechanic finds the bent wheel. It’s right there. The parts are on the shelf. But the rules say, “You can look at it today. Fix it another day.” So you leave, take more time off, and come back. Nothing about that helps the car.

Health care is moving in that direction. In the summer of 2026, CMS proposed a new payment rule for 2027. CMS is the federal agency that runs Medicare, and it sets many of the payment rules that private insurers follow. The proposal would cut payment for the exam visit in half when a procedure is done that same day.

The rule is not final yet. CMS tried a similar idea in 2019 and chose not to go through with it after doctors pushed back. The final decision is expected in November 2026. Many physician groups, including the AMA, have spoken out against it.

Because we work outside of insurance networks, rules like this don’t decide how we care for you. When it is safe and it makes sense, we can evaluate you and treat you in the same visit.

05 · Out of Network, Explained

Out of network does not mean out of luck.

Many people think “out of network” means their insurance pays nothing. That is often not true.

Many health plans have out-of-network benefits. That means the plan will pay back part of the cost when you see a doctor outside its network. You pay the clinic first. Then you send a claim to your insurance. If the claim is approved, the insurance company pays you back.

Here is how it usually works by plan type. Always check your own plan, because every plan is different.

06 · Meet Reimbursify

The claim service we pay for, so you don’t have to.

Filing an out-of-network claim used to mean paper forms. You had to find the right form for your plan. Fill it out by hand. Attach your receipt. Mail it. Then wait, and hope nothing got lost.

Many people never filed at all. The money they were owed just stayed with the insurance company.

That is why we use Reimbursify. It is a separate company that files out-of-network claims with insurance companies for you. It works on your phone through an app, or on a computer through their FileFast website.

• ·Fast. Reimbursify says you can file a claim in less than a minute.
• ·No paper. You enter your visit details from your superbill. They send it to your insurance company.
• ·Trackable. You can check where your claim stands at any time.
• ·Paid to you. Approved claims are paid by your insurance company straight to you.
• ·Private. Reimbursify states that its platform is HIPAA compliant. HIPAA is the federal law that protects your health information.

After you file, most insurance companies take about four to six weeks to process a claim. Then you get a letter called an Explanation of Benefits, or EOB. It shows how your plan handled the claim. If money is owed to you, a check or payment usually comes with it or soon after.

07 · Who Pays for It

We pay for it. We don’t pass it on to you.

This is the part many people don’t know. Reimbursify is not free. When a patient’s clinic is not a member, the patient usually pays a small fee for each claim.

We pay for a Reimbursify membership for our patients. That means you can file your claims with no filing fee. We don’t add the cost to your bill. We don’t raise our prices to cover it. It is simply a cost we chose to take on.

Think of it this way. We pay a company whose whole job is sending out-of-network claims to insurance companies the right way. That gives you a better chance of getting back what you are owed for the care you deserve.

08 · Step by Step

How to get money back, one step at a time.

A tip: file after every visit, or at least once a month. Most plans set a deadline for filing claims. Waiting too long can cost you money.

09 · Call Your Insurance

Seven questions to ask before your first visit.

Five minutes on the phone can save you a lot of surprises. Call the number on your insurance card and ask:

• ·“Do I have out-of-network benefits for outpatient doctor visits?” If the answer is no, the rest won’t apply. That is good to know up front.
• ·“What is my out-of-network deductible, and how much have I met this year?” Your deductible is the amount you pay each year before your plan starts paying. The out-of-network deductible is often separate from, and higher than, the in-network one.
• ·“After I meet the deductible, what percent do you pay back?” This is your coinsurance. Many plans pay back somewhere around 50% to 70% of their “allowed amount.”
• ·“How do you set the allowed amount for out-of-network care?” This is the price your plan decides is fair. It is often less than what the clinic charges.
• ·“Is there an out-of-network out-of-pocket maximum?” This is the most you would pay in a year before the plan pays more.
• ·“Do any services need approval ahead of time?” Some plans want approval before certain procedures.
• ·“How long do I have to file a claim?” This is called the timely filing limit. Ask so you don’t miss it.

10 · The Money Math

How much will you actually get back?

We want you to have real expectations, not false hope. How much you get back depends on three things: your deductible, your coinsurance, and your plan’s allowed amount.

Here is a made-up example to show how it works. These are not our prices, and they are not your plan’s numbers.

Look at the second column. You may get nothing back on your first few visits. But those claims are still worth filing. They count toward your out-of-network deductible. Once you meet it, your plan starts paying you back on future visits.

11 · Choosing a Plan This Fall

Open enrollment is here. Pick a plan with out-of-network benefits.

This is the time of year when most people pick their health plan for next year. It is the best chance you’ll have to make out-of-network care cost less.

If you buy your own plan on HealthCare.gov, open enrollment runs from November 1, 2026 to January 15, 2027. Pick a plan by December 15 if you want it to start on January 1. If you get insurance through work, your employer sets its own dates. Many hold open enrollment in October or November. Ask your HR team.

Many people pick the plan with the lowest monthly price. That plan is often an HMO or EPO. Those plans usually pay nothing for out-of-network care. A plan that costs a little more each month may pay you back far more over the year.

If you already know you want care here, bring the plan choices to us. We are happy to help you think through which questions to ask. We can’t pick a plan for you, but we can help you know what matters.

One more note. If you are turning 65 or moving to Medicare, remember that we do not accept Medicare or Medicare Advantage. Plan ahead so you know how you’ll pay for care here.

12 · Your Rights

No surprises. Clear prices up front.

Because you pay us directly, federal law gives you extra protection. Under the No Surprises Act, patients who are uninsured, or who choose not to bill their insurance through the clinic, have the right to a Good Faith Estimate. This is a written estimate of what your care is expected to cost.

• ·You can ask for a Good Faith Estimate when you schedule, or any time before your visit.
• ·If your final bill is at least $400 more than the estimate, you may be able to dispute it through a federal process.
• ·Our prices are posted and explained before you are treated. You will not get a surprise bill from us.

You can learn more at cms.gov/nosurprises, or ask our front desk.

We believe clear prices are part of good care. You should know what something costs before you agree to it. That’s how it works everywhere else in life.

13 · Why We Chose This Model

We chose the care. Then we chose to help you pay for it.

We could have built a different kind of clinic. One that takes every plan. One with fifteen-minute visits and a long line in the waiting room. One that offers only what insurance pays for.

We didn’t, because that’s not what our patients need. Many of them have already been through that system. They had the scans. They did the therapy. They got told “everything looks normal.” And they still hurt.

What they needed was a doctor with time. A doctor who could find the real pain generator and had the right tools to fix it. That is what we built.

If you have questions about cost, insurance, or reimbursement, please call us before your visit. We would much rather talk it through than have you worry about it. There are no bad questions here.

Sources

1. Reimbursify. FileFast claim filing portal. filefast.reimbursify.com
2. Reimbursify. FileFAST: claim filing tool (filing time, claim tracking, direct payment to patient). reimbursify.com/filefast
3. Reimbursify. How out-of-network reimbursement works (processing time, Explanation of Benefits). reimbursify.com/how-out-of-network-reimbursement-works
4. Reimbursify. For practitioners (member practices, HIPAA-compliant platform). reimbursify.com/for-practitioners
5. Centers for Medicare & Medicaid Services. No Surprises: What’s a Good Faith Estimate? cms.gov/nosurprises
6. Centers for Medicare & Medicaid Services. Patient-provider dispute resolution for uninsured or self-pay individuals ($400 threshold). cms.gov/nosurprises
7. American College of Surgeons. A proposed Medicare payment cut you should know: modifier 25 and overlapping services (CY 2027 Physician Fee Schedule proposal, 50% same-day E/M reduction). facs.org
8. American Medical Association and physician organizations. Sign-on letter to CMS Administrator Oz opposing the modifier 25 proposal, August 27, 2026. PDF
9. HealthCare.gov. Dates and deadlines for open enrollment. healthcare.gov
10. Aetna. Cost of out-of-network doctors and hospitals (allowed amounts, balance billing). aetna.com