Why Cash Based PT May be More Bang for Your Buck
First, let me begin this post by saying that I am by no means against having health insurance and think everyone should have it for those unforeseen medical expenses that can pile up quickly following an illness or surgery.
With that being said, dealing with insurance companies when it comes to receiving physical therapy kind of sucks.
Most insurance companies have “limits” to the amount they are willing to pay when it comes to healthcare services. Physical therapy, for example, will often only be covered for a certain number of visits, with some insurance companies only approving small chunks of visits at a time. They also decide what types of physical therapy services they will pay for, and which ones they will not, which I’d argue certainly influences your treatment plan (would you provide a service that you wouldn’t get paid for?). Once you use the number of visits your insurance company will approve and they determine PT services are no longer needed, they will not pay for any additional treatment you receive. I’ve seen this happen a number of times in my years of treating and it is incredibly frustrating for PTs and patient’s who feel like the job isn’t finished and their goals haven’t been achieved.
This brings me to the topic of this post: cash based, out of network, physical therapy. What does out-of-network mean? It indicates that the healthcare provider you are seeking care from does not have a contract with your insurance company, meaning they do not bill the insurance company for services provided. This means that the price of any service is the responsibility of the patient/client. I know this may sound like a deal breaker already but hear me out on why this can actually be the best bang for you buck.
High deductible insurance plans are becoming more and more popular with employers because they’re cheaper to provide. With a higher deductible plan, you pay more money out of pocket for services before your health insurance kicks in. These plans usually include a Health Savings Account (HSA) or a Flexible Spending Account (FSA) which is money taken out of your paycheck every week to basically help pay your high deductible. The good news is this money can be applied to out-of-network services, so paying for such services does not always have to come right out of your pocket. Plus, if you went to an in-network physical therapy provider, you may be required to pay the full price of those visits anyway until you met your deductible without the benefits of seeing an out-of-network PT, which is summarized below.
First, when working with a cash-based therapist like myself, you get my undivided attention for a full hour as compared to having to split your time between 2,3, or sometimes 4 other patients at once. With so much undivided attention to your complaints, limitations, and progress, we can solve your issue in fewer visits and get you back to crushing your goals in a shorter amount of time. When you consider the amount of time spent 1 on 1 with a cash-based therapist for the price you’re paying, getting better faster is often no more expensive, and sometimes cheaper, than having more visits with an in-network therapist where your time (and their attention) is split with other patients.
Another plus is we don’t have to abide by what an insurance company “approves” vs. what is not approved. Your treatment plan is entirely up to you and your therapist from the things we do to how many times we see each other. If it’s something that will help you get out of pain and return to activity, we do it. You want to get treatment once a week for an entire year to keep your body in tip top shape and competing at the highest level? No problem. You have multiple body parts you want evaluated and treated all at once? We can do that.
Now, although cash-based providers don’t bill your insurance directly, your insurance company may still reimburse you for some of the cost. Each of our clients are provided what is called a “superbill” which will contain the proper codes and amount paid that you could submit to your insurance company and possibly receive some compensation in return. This may not be 100% of the cost of services paid for, however reimbursement of even 50% could have you end up paying the same amount in the long run when compared to paying for in-network services if you haven’t yet met your deductible.
Finally, think of all the things we pay the more expensive option for. Most of us have no problem upgrading to the newest iPhone that cost hundreds of dollars, buying an expensive car that gets us from point A to point B just as well as a cheaper one, and don’t get me started on paying an absurd amount of money on clothing just for the name stitched onto it. What do all these things have in common? They’re all replaceable. Yet we will still spend the extra money on them. So, my question to you is: why wouldn’t you invest in your body and physical health the same way? If you want to perform at the highest-level during competition, stay in the gym to achieve your fitness goals, or just move without pain so you can play with your kids, investing in your physical health and well-being is great start. Take care of your body, and it will reward you by giving you the ability experience life through pain free movement.