I’ve put a lot of reasons out there for why clients should choose an Out of Network (OON) or cash based PT but here's a few reasons why I have personally chosen this path as a clinician.
I’ve worked in multiple orthopedic environments over the past 15 years....athletic training room, non-profit, private practice and corporate organizations. I have seen and felt the push of “higher ups” to get more patients through the door. Here are a few reasons why I'm choosing cash based PT:
Insurance Dictating Care:
I feel insurance is dictating care rather than the Physical Therapist. After an evaluation it doesn’t matter what my clinical prognosis is, the insurance will give me a number of visits based on what they think. And if you have higher level goals like running a marathon, returning to CrossFit or back to a sport good luck with getting visits approved. I have been told in the past by my directors not to document goals of running, jumping or return to sport as the insurance would automatically deny. How absurd to not have goals like this for a high school athlete.
Insurance Based Physical Therapy Has Failed Them:
I have had many conversations with clients at the gym who have gone through an insurance based clinic and complain to me that the PT didn’t pay attention or they did exercises on their own while the PT was busy treating another patient.
I hate when I hear this, the sole reason the person is coming to Physical Therapy is for the therapist’s expertise and not to be pawned off to someone else who is unskilled or do their exercises unsupervised. What's the point of them coming if they are not getting the help they seek.
I have been in this predicament in the past working for an insurance based provider expecting me to see 3-4 patients in an hour. Honestly it’s not fair to either side.
At the end of the day I would be so frustrated having run around all day knowing my quality of care sucked just because I didn’t have the time to do what was needed for my patient.
An added bonus was the paperwork. I always had to be on the computer at the clinic staying on top of notes further taking away from my interaction with my client. It became impersonal.
The Numbers Game:
The numbers game was also another reason I struggled with the way insurance based clinics are run. It didn’t matter the diagnosis or what the patient was going though, everyone was expected to get their patients in 3 times a week. This was more of a business strategy than truly looking out for the patient.
Insurance Reimbursement Is Not Affected By Quality Of Care:
The biggest slap in the face was during COVID for me. My goal was always to be a great clinician so over the past 15 years I did that by taking multiple continuing education classes and obtaining certifications. When COVID hit I was forced to start looking for a new job. The business part of insurance based PT really hit when I came to understand it no longer mattered if you were a skilled practitioner. In the insurance based world it doesn’t matter if you're a new grad or experienced clinician, there is no merit for skill level. My billing and reimbursement rate would be the same as the new grad. As a business it just doesn’t make sense for the insurance based practice to want to pay more for an employee based on experience or skill.
These are some of the big reasons why I chose to begin a Cash Based Physical Therapy Practice. To have a better balance and provide patient care the way it should be not dictated by business or insurance. If this resonates with you and you are looking for more individualized care, reach out, I’d love to help.
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