Cash Based PT vs Insurance
Cash based PT is worth the investment both financially and for quality of care. Surprisingly enough, it can save you money in the long run.
Insurance is helpful & necessary in so many instances, i.e. many of my patients birth in hospitals; the amount covered by insurance makes that possible.
Having spent the majority of my career working in an insurance based model I had a lot of patients receive surprise bills after high deductibles and co-payments. They would have beneficial services not covered, such as dry needling, and have to pay for these out of pocket at an additional cost ranging $45-$60 per visit. To put that into perspective, a patient was often seen 2-3x/week for 6-8 weeks with a $75.00 co-pay totaling $150-$225 and still having to pay money until they meet their deductible, all the while sharing that time with another patient and in a lot of clinics are only seen for 30-45 minutes. Multiplying this out further by the weeks you get the point how that can quickly add up for your plan of care. Since the cash based model allows complete 1:1 time, I can see patients 1x per week, for a whole hour or more, making their total cost less & there is complete transparency in what it is going to cost. You are also saved time by not having to try and schedule 2-3x per week.
Insurance will try and dictate what you can and can’t do. This creates a necessity of productivity standards for physical therapy clinics. Working on the insurance side of PT, I was at times seeing four patients all at once in an hour, thus really unable to give my full attention to any one of them for more than a few minutes, i.e. a single timed code, dictated by the insurance typically ranging 8-15 minutes for manual therapy. In a cash based model, we are able to spend a whole hour or more 1:1 and do not have timed codes to meet. Being a doctorate level educated practitioner, we know how to best treat our patients & that is what we went into the field for. With insurance, visits were often cut off and treatment plans dictated (low back pain gets 6 visits)…?! It doesn’t even make sense how these arbitrary numbers are calculated. How can someone who has never treated a patient with back pain, are not educated on tissues and the healing process, have not seen the patient in front of them, or know of their story that may lead to a need for more care dictate how many visits it will take for them to get better?
It also leads to an inability to treat multiple body parts; having pelvic floor issues and hip or knee pain. Insurance requires a whole new treatment plan to address a different part of the body. If you were in an insurance model seeing a PT for low back pain, and your hip started bothering you, you would have to try to fit in a specific time for a re-evaluation, and have a new treatment plan created, whereas it is something we would just address so you don’t have other problems from compensations from it.
Most of us go into this field to treat patients to get better and have lasting success. Physical therapy, especially pelvic floor physical therapy can be a very personal experience and a lot of times can be very emotional. Being able to have a private session and a full hour to work on things in your own comfortable setting allows for better outcomes and quality of care. When you are invested in your health it is important to find the right clinician, especially when initially paying out of pocket. Your health requires time, dedication, and energy-- just searching for the quick fix, or fitting into a system that is “covered” will likely have you seek the care and treatment you needed before at a later date anyway, but we’re always here to help if that doesn’t work out for you!
