But, I have insurance to cover my medical costs. If I pay out-of-pocket I won't be reimbursed by my insurance company.
These are a few of the things I've heard when it comes to a cash-based physical therapy practice.
Isn't it more expensive? Well, not necessarily.
A lot depends on your insurance. You may have noticed that a lot of things when it comes to your healthcare depend on your insurance. What doctor or hospital you can go to, what medicines or tests can you get. The same things happen in physical therapy.
You should know a few basic things about your insurance. These are the deductible, copays/coinsurance, coverage of physical therapy, differences between in-network and out-of-network coverage (you could have different copays or deductibles.)
When you look at your insurance you may notice a few things. You may have a deductible of a few thousand dollars (or more than a few), maybe a $50+ copay, or maybe little to no coverage for physical therapy. And, at a typical in-network physical therapy clinic, you may have to pay a bill of $200+ per session and you won't have been billed until weeks after your appointment has happened and you already went 5 more times.
Why so much? Well, insurance companies have been paying physical therapists less each year and so we have been billing insurance companies more for each visit though overall reimbursement keeps falling. If you still have your deductible to meet then you can be stuck with this whole bill!
Ready to try something other than the old insurance model? Cash-based physical therapy could be right for you. When you pay upfront for your care you know exactly what you are going to pay and can budget appropriately. No surprise bills 8 weeks from now. Because you know exactly what each session will cost you and your physical therapist can have an open and honest discussion of how many in clinic sessions you may need and how much you can do on our own to take care of yourself (hint: 90% of health is on each individual and not the health care provider).
I don't really want to see people 3x a week for 6-12 weeks. I would love to see you 1x a week or every other week for 5 sessions and then maybe see how you can do mostly on your own with some tune-up session now and again. (The exact plan of care and how many sessions you may need are very individual and can only be decided by you and your physical therapist.)
Can I be reimbursed for my out-of-pocket charge? This depends on your insurance, but most of the time the answer is YES! You can send a 'self-claim' with appropriate treatment codes and receipts which we can provide to you upon request.
How much will I be reimbursed? Again this depends entirely on your insurance. You will have to meet your out-of-network deductible first. Then it may be a percentage (e.g. 40%) or only up to a certain amount (e.g. $50).
I hope this clears up some of the confusing mess that is insurance and shows how a cash-based physical therapy practice can be a cost-effective and money saving option for your physical therapy care.
So if you have amazing insurance with no copay, a deductible of $250 and 100% PT coverage a cash-based PT practice may not be the most cost-effective option. But there are other factors at play that I will go over in future blog posts that could still make it worthwhile.