Private Pay vs Insurance Based Physical Therapy
Private pay physical therapy is more cost effective and provides better outcomes when compared to insurance based physical therapy. I wanted to take a minute and educate our audience on the benefits of direct consumer, self-pay physical therapy.
The picture above does a great job of summarizing the most important benefits to private pay physical therapy. With private pay there is a lower number of average visits, lower cost of care, and 100% of your treatment is spent with your physical therapist. In the private pay world, we get our patients better faster.
Insurance Advocate vs Physical Therapist
The hard thing for myself, and many therapists, is this new business model and insurance limitations of the profession. Most of my time as a therapist, I felt more like an insurance advocate. I would explain insurance benefits, check and recheck benefits, authorize care, explain cost and limitations to care as per the insurance company, etc. I always made this a priority prior to me seeing the patient as a way to be transparent in my approach and be aware to limitations I was given by insurance. If insurance would allow me to treat the way I wanted, I would have never left the world of insurance and opened up a self-pay office.
Corporate American
There is also a movement in healthcare where privately owned businesses are disappearing and being bought out by Corporate American. For many reasons, this can be a positive movement and can help to streamline care. Lets be honest, we are all thankful for our insurance. As for what this is doing to the profession of physical therapy, however, is a different story. Lets focus on the main issue at hand: It’s only a matter of time until the profession is too expensive for the consumer. Insurance companies want to be contracted with the big healthcare providers. Think of your PCP who use to be privately owned and recently got bought by a large healthcare company. Reimbursement to the provider has gotten so low over the years, many have been forced to sell. When I was in private practice we would bill around $180 to the insurance for an hour of care. Reimbursement was around $68-82 per claim, barely enough to stay employed and keep the lights on. The contracts with corporate health systems are so high I have actually seen a patient be billed over $900 for an initial evaluation. Another example is of a patient who was billed $1,361.04 for two sessions because her insurance denied the claim due to lack of pre-authorization. This makes $100/session that I charge not seem so bad, am I right?
PT Mill
The “PT mill” setting is getting more and more popular with big companies. High patient volume, low quality of care. How many of you have heard or even said yourselves, “Physical therapy doesn’t work for me.” Does it really not work, though? Or did you not get quality care and the time you deserved with your physical therapist and were you forced to work with an assistant or aide? Were you limited in the amount of visits your insurance allowed you to have? Was your poor therapist forced to see 28 patients in a 10 hour shift leaving him/her no time to eat and use the bathroom? Was your co-pay $60 and you still hadn’t met your deductible so you couldn’t afford to fulfill your treatment plan?
Offset Costs
Luckily, there are some ways to offset high deductible insurance plans. Health saving accounts (HSA) and flexible spending accounts (FSA) can be accepted by your cash-PT provider. These accounts are provided by an employer as a way to help with medical costs. Some benefits include:
Contributions are pre-taxed
Contributions are tax deductible
The list of qualified medical expenses is large (ie: physical therapy, contact lenses, prescriptions, copays, etc)
Convenience. These accounts issue a debit card so you can pay for expenses.
Your out-of-network physical therapist can also provide the patient with all of the necessary paperwork to submit for reimbursement to the insurance company once your deductible has been met. Oftentimes patients will be hesitant to seek out-of-network services due to feeling obligated to stay in-network due to a deductible being met. Don’t let this stop you from receiving quality care!
So much has changed in the profession, even in the short time I have been around. If I could have anything in my career, it would be a small voice of how we can better care for our patients as clinicians. If you have any questions about self-pay PT, feel free to reach out.