By: Dr Dawn
I am often asked why I do not accept insurance payments at my practice. “Don’t you want more business?” “Is anyone willing to pay cash for physical therapy services?” “Why would I want to come to you instead of someone who accepts my insurance?”
The restrictions placed on my services by third-party payers interfere with my ability to help patients reach their goals. Additionally, the cost of collecting payment from third-party payers and the difficulties in negotiating rates with insurance companies undermine the financial viability of an insurance-based practice. For these reasons, I choose a cash-based model for my practice. It frees me to treat my patients as I deem necessary for full return to living their best life whether that be walks in the park or an Ironman triathlon. Every person deserves more than a perfunctory “return to functional status”. This is insurance speak for the ability to walk, drive, return to work, etc. It does not include return to sport and many claims are denied past the dreaded “return to functional status” determination.
And cash-based practice is often similarly affordable for the consumer as an insurance-based practice. Let’s take a quick look at the numbers!
|Modality||Appt Time||Ave # of visits||Ave Cost|
|Cash||Full hour w/PT||1-2/wk x 4-6 wks||$75-$150 x 6 = $450-$900|
|Insurance||15-30 minutes w/PT||2-3/wk x 6-8 wks||$50-$75 x 8 = $400-$600|
Please note that more quality time is being spent at each physical therapy visit in a cash-based practice which often results in quicker healing times for clients. More quality time with less overall frequency and duration… time as well as money is money my friends!
Also, many insurance companies do reimburse their beneficiaries for services rendered outside their plans. I freely offer super bills with all the necessary coding for self-submission to insurance companies. Most of my clients who opt to self-submit are reimbursed reasonably well depending on their actual policy guidelines. At the very least, many insurance companies will allow the out of pocket costs of cash physical therapy to assist in meeting the beneficiary’s deductible and/or out of pocket expenses for the year. Every person’s insurance policy is unique, and I advise everyone to know your policy guidelines especially for out of network providers. Many physicians and some physical therapists are opting for out of network status and trending towards cash-based practices, so most of us will encounter this new wave in healthcare.
I highly recommend adopting a healthy lifestyle where self-care is performed daily. This may include healthy nutrient dense food intake, exercise (strengthening/stretching/cardio of your choice), myofascial release, and practicing good postural alignment in all daily activities. This will limit your injury exposure. Use movement and food as medicine and you’ll keep the doctor at bay!