WAIT?! WHAT?! YOU DON'T TAKE INSURANCE?!
One of the biggest questions I get asked regularly is, (you guessed it) “Do you take insurance?” The short answer is no. Now before you say something like, “forget this guy” or “I have insurance so I can use it” or how this old chestnut “I can’t afford to pay cash, using my insurance is cheaper.” (I’ve said that one), hear me out. How many of you have been surprised by the size of your bill from either a physician’s office, physical therapy office, or pharmacy; even with your insurance? You get the bill and think, “there’s no way they billed my insurance. That is way too high!” Yup, I’ve been there too. You are not alone.
We’ve been conditioned to think that insurance is the way to go because healthcare costs are too high. Well, insurance is part of the problem when it comes to the rising cost of health care. Tell me another industry where you call to get a price on something or some service and they say, “it depends”. If I call down to the grocery store and ask for the price of milk, they can tell me the price of milk. If I go to get my oil changed the guy at Jiffy Lube can tell me how much that oil change will cost, he can even try to upsell me on other services, but he has a price ready for me. It doesn’t depend on my car insurance, a deductible, or the phase of the moon. The price is the price. Now if I’m calling about physical therapy and I have Insurance A and I haven’t met my deductible the price of treatment is one price, and it’s a different price if I have Insurance B and I have met my deductible. The cost to me is different even if I have Insurance B and I haven’t met my deductible.
Well, that doesn’t seem fair or to make any sense at all. Exactly! So let's look at it this way.
INSURANCE A = $150/session INSURANCE B = $115/session INSURANCE C = $97/session
Insurance A will pay out $150/session to your provider for that physical therapy session and Insurance B and C pay significantly less. Now you haven’t met your deductible yet, but you need physical therapy. How much do you think you’re going to pay for that session? If you said $150 you would be correct.
“But I have insurance B and my company pays only $115/session,” you say.
While you are correct, the provider has to bill at the highest reimbursement rate to get paid the $150 Insurance A is willing to pay.
If you had opted to not use insurance and decided to pay cash the cost of that session might be only $125 or whatever the cash rate they charge is. Let’s assume you used your insurance and had met your deductible. Then we get into in-network vs out-of-network rates, your co-insurance percentage, copay, out of pocket maximums, and other stuff. Suffice to say, even when using your insurance you still may end up paying more out of pocket.
If we are dealing with a regular physical therapy clinic where they take insurance, generally you are looking at 3 times a week for at least 4-6 weeks. Do the math, on the conservative side 12 visits and the high side 18. Even if you have met your deductible the time and cost would seem prohibitive. It would seem the current insurance-based model is designed to keep you in the clinic longer and get more money out of you.
So, is a cash-based practice better?
In a study performed on a cash based physical therapy clinic in Orlando, FL researchers chose 48 charts at random of discharged patients. The findings are as follows:
• The total cost of care for the cash-based practice averaged $780 (median of $600); the insurance-based study identified a total average cost of $936. Patients in the cash-based system averaged a per-visit cost of $97.52.
• Patients seeking treatment for low back pain (LBP) made up the bulk of the caseload, at 39.6%. The second most common diagnosis was leg or knee pain (29.2%), followed by cervical/thoracic pain (14.6%).
• Average patient NPRS score at evaluation was 6.9 (with a variation of plus or minus 1.9 points), and at discharge was 1.1 (plus or minus 1.9 points). In all cases, patients met the minimum clinically important difference for change in NPRS scores.
I often work with people who perform at a high level. They are athletes, Crossfitters, gym rats, entrepreneurs, professionals, dancers, parents, and weekend warriors. But they all come to me frustrated because they can’t move the way they want to and are unable to perform at the levels they know they are capable of due to pain and injury and the traditional insurance-based physical therapy model has not been able to help them. At Polaris PT & Wellness we are strictly one-on-one clinic, can save you time and money, and get you back performing at the highest levels by treating outside the traditional model in a cash-based practice.
Helping people recover from pain and injury is what we do.
Empowering others to live their lives one movement at a time is who we are.
1. Pulford K, Kilduff B, Hanney WJ, Kolber M, Liu X, Miller R. (2019). Service Utilization and Costs of Patients at a Cash-Based Physical Therapy Clinic. The Healthcare Manager. (38)1, 37-43