Most individuals are hesitant to see a cash based PT or go OON. Why pay out of pocket when you pay good money for health insurance. It makes sense but is it the most cost effective and quality care you can receive? That answer is not always yes and here’s why….

 

When you go to an In network provider they will bill your insurance using diagnosis and treatment codes along with units for the time spent treating. The insurance company will then dictate how the clinic will get paid. It doesn’t matter the quality of care provided, just what codes and units were punched in for the day's treatment.

Insurance companies will also reimburse(pay) clinics at different rates. This may bias the business to see multiple patients at once or even see the patient for less time due to the low reimbursement rate. 

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Insurance companies also have their own ways of minimizing expenses on their subscribers. Some Insurance companies utilize third party regulators to manage authorizations. An authorization is what your PT provider will submit in order for insurance to reimburse for treatment. So even if your Doctor writes a script or the PT requires so many visits to address the problem the insurance ultimately decides your fate.

Even if you have 30+ visits a year with your insurance doesn’t mean you will be allowed to use them at your will.

Most insurance companies' goals for your care are to cover activities of basic living (sitting, standing, walking). Meaning they won’t care or pay if you want to get back to running, play pickleball or any other high level hobbies you value. 

 

So in summary what does this potentially mean for you as the patient?

Less time with your Physical Therapist

Decreased Quality of treatment

Inability to meet higher level goals. 

= time and money wasted. 

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Traditional health insurance fosters a culture of more visits over a longer period of time and high patient volume. The cash based Physical Therapy practice challenges that system. It benefits both the patient and practitioner and here’s how: 

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1) One-on-one time with your PT

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In network insurance based PT offices tend to be pretty busy. You’ll see that there are more patients per number of PT’s in the office. Most clinics have their PT’s see multiple patients in the same hour. The clinic will utilize support staff such as aides or PTA’s to assist with treatment. This means less time with your PT and having to switch between multiple people during a treatment session diminishes the continuity of care from your provider.

 

When you go out-of-network or cash pay, that drastically limits the overhead usually involved with billing insurance as well as low reimbursement that drives many clinics to be forced to see multiple patients at once.

 

At RPT we only see 1 patient at a time. That means that when you come for your appointment it’s just you and your PT for the entire appointment.  That increase in time spent with your PT helps cut down on the number visits you need overall because more can be accomplished in a single session.  This means you can be educated throughout your session, adjustments made on the fly as needed and always have the most highly skilled eye on you during your treatment to ensure you’re doing everything right. 

 

2) No insurance limitations or insurance dictating your care

 

Many plans also have visit limits or markers that when you meet them, they won't cover any more visits, the fact that you may not have reached your ultimate goal does not matter. 

 

Also, what about that insurance plan that's supposed to cover health care costs and you just pay a copay or coinsurance payment?  That's great, but there's this thing called a deductible that you have to meet and in most plans, PT is a covered service but only after the deductible has been met meaning you're paying full price out of pocket anyway until you reach that $3000, $4000 or $5000 deductible (some are even higher than that!).

 

RPT believes that we (your PT and you) should be the ones making decisions about your PT care, not your insurance company.  That's why we choose to go out-of-network.

 

3) Efficient use of Time 

 

If you received traditional insurance based PT before then you know it can be a huge time commitment. Going 2-3 times a week for 6-8 maybe even 12 weeks! At the end of a completed care you could potentially be looking at 12-36 visits!

 

With a cash pay physical therapy, because of the complete 1:1 time with your PT, you usually need far fewer visits.  Many of our patients only need to come once a week and our average number of visits overall for a plan of care (or a course of treatment for a certain injury/pain/dysfunction) is about 6-8 visits.  What sounds better, 6-8 visits or 12-36?

 

During that one on one time we work to make sure that you understand what you need to be doing on your own at home in order to get better.  Yes, that means you will have homework, but you will better understand your injury and have the tools to help yourself.  And not to mention, fewer visits overall means less time away from work, fewer drives to the PT clinic and more time with family and friends!

 

4) Increased Accessibility to your PT

 

If you go to a big PT practice and you have a question in between sessions, chances are you'll have to call and leave a message with someone at the front desk and then wait for a call back before you get your answer.

 

RPT’s goal is to have open communication with our patients in between sessions, to improve patients confidence and control of their recovery.   You can reach us anytime between appointments through email, a call or text message.  

 

5) Potential Cost Savings

 

While paying out of pocket may initially seem more expensive, cash based clinics can offer cost savings in the long run. Cash based clinics offer straightforward fee for services. No hidden fees or unforeseen bills after you have completed your PT course of treatment. Additionally by receiving focused and individualized care, patients may experience faster recovery leading to overall reduction in healthcare costs. 

 

In some cases, you may be able to submit a claim to your insurance provider for out of network services. While we do take payment prior to each appointment, upon request we will also provide you with a super bill with all of the information your insurance company will need to create your healthcare claim. Based on what your particular insurance covers, they will send a refund directly for you for any covered services.