Do you accept my Insurance? This is hands down the most common question I get asked when talking with potential patients. My answer is…no, but depending on your insurance provider, I can provide you with a bill that you can submit to your insurance company for possible reimbursement or to go towards your deductible. Usually after that, I get one of three responses: 1) silence, 2) I will contact my insurance company and get back to you, 3) I want to use my insurance, I am not going to go somewhere where my insurance isn’t accepted.
So, why are people so adamant about using insurance and why is fee for service/cash based services such a taboo idea? What are the problems with insurance and how can a cash based approach resolve these problems? Let’s dive into it….
Previously, I practiced in a traditional outpatient orthopedic physical therapy (PT) clinic, where the vast majority of our patients used insurance. Don’t get me wrong, insurance is a must have. I have health insurance myself and would never go without it, but is it always necessary to use? Do you always get the most value by using your insurance?
We have insurance for a lot of things in our lives, such as car insurance or home insurance. Do you always use these insurances when an issue arises? Let’s say you need a new headlight or an oil change, do you use your insurance for that? Or you have to have a plumber come out to repair a leaky faucet or you need your house pressure washed. Do you use your insurance for that? The answer is probably, no.
So let’s say you sprain your ankle and need 4 PT visits to get you back playing tennis or you have chronic back pain and need 6 PT visits to get you back playing golf. Why do you have to use your insurance? Now, let’s say you get in a car accident and need to be in the hospital for several days then yeah, definitely use your insurance, this will be a big bill! But just because you have it, doesn’t mean you necessarily always need to use it.
So let’s look at the facts….
1. Cost of Care
Cost of care is the main reason people steer away from a cash based model and want to use insurance, thinking that using their insurance will save them money. Copays and number of visits vary greatly for PT, but typically 2x per week for 6-8 weeks is a normal plan of care for PT in a traditional outpatient clinic. The average deductible for commercial insurance also ranges greatly, but since PT is considered a specialty, it can cost up to $150 a visit under high-deductible plans. So let’s say, 12 visits at $75 per visit = $900. Where cash based, you will likely be seen for a total of 4-6 visits at $125 per visit =$750 (this is if you do not submit your bill to your insurance company for possible reimbursement, which can make your bill even lower). With high deductible plans being used more often, you will be paying for all of this out of pocket until that deductible is met.
Now this doesn’t include the visit to your doctor, cost for imaging, medications, and possibly referrals to other doctors such as pain management or an orthopedic. All of which will likely lead you ultimately to PT anyways! A study from 2021, showed that direct access to physical therapy versus physician first treatment reduces physical therapy costs, overall healthcare costs, number of physical therapy visits, and significantly improved functional outcomes in patients.
2. Quality of Care
When providing cash based PT, the therapy cannot be equivalent to traditional PT services, it needs to be superior! At our clinic, you will be seen by the same Doctor of Physical Therapy (DPT) at each visit. You will not be moved around to other PTs, assistants, or aids. You will get a full, one hour treatment session. You will not be double or triple booked with other patients, which is required to maintain profit in a traditional PT setting. You will also have direct contact to your PT to ask questions and report updates on a regular basis, you won’t have to wait until your next appointment to address any potential issues or concerns.
3. Accessibility to Care
One big issue with traditional PT is the wait time needed to get seen, sometimes you may have to wait weeks for your first PT visit. PT, like any treatment, is more effective the quicker the treatment process starts. At our clinic, you will not be put on a waiting list due to overbooking and risk potentially not getting seen for an appointment during the week, which can negatively impact your prognosis and recovery time.
4. Specificity of Care
Specificity of care is vital to addressing the needs of each individual. It is easy to get in a rut with physical therapy doing the same exercises over and over again with patients. However, at Bailey Physical Therapy and Wellness, each plan of care and treatment session is specifically designed based on your initial evaluation and progress week to week. This results in quicker recovery, better functional outcomes, and reduced number of visits compared to traditional PT.
Cash based PT also gives you the freedom to tailor your PT based on what you need, not just to be treated for the specific diagnosis you were referred for. We offer a variety of options including: wellness treatment, dry needling, cupping, and you can be treated for any body part(s) of choosing.
5. Results of Care
As previously mentioned, cash based PT provides better functional outcomes at a reduced visit count and duration. This allows you to get back to the activities you enjoy sooner and with improved performance to improve your overall quality of life.
Resources:
1. (2020, September 3). High deductible health plans and health savings accounts. Employee Benefits Survey. https://www.bls.gov/ebs/factsheets/high-deductible-health-plans-and-health-savings-accounts.htm
2. Hon S, Ritter R, Allen DD. Cost-Effectiveness and Outcomes of Direct Access to Physical Therapy for Musculoskeletal Disorders Compared to Physician-First Access in the United States: Systematic Review and Meta-Analysis. Phys Ther. 2021 Jan 4;101(1):pzaa201. doi: 10.1093/ptj/pzaa201. PMID: 33245117.
