Updated: Aug 30, 2021
I have been talking on my Instagram and Facebook pages a little about the cash pay model, but wanted to take an opportunity to dive a little deeper into the model, why I chose to set up my practice out of network, and who might be best suited to pay cash for physical therapy services. Read on to find out how you could benefit, why you might not be eligible, and how I am addressing equity in my practice.
I maintain an additional license that allows you to directly refer yourself to me for treatment. I'll loop your doc in if they need to be informed of your care, or of course, at your request. It's usually a good idea if the folks involved in your medical care are communicating; afterall, the left hand should know what the right hand is doing. But, you know your body best, and if you think you need PT, calling me for a consultation could save you the time of waiting to see your primary or a specialist, copays/deductibles, and potentially unnecessary tests. This direct route to PT is good for uncomplicated conditions, an acute back injury or an ankle sprain, a runner with nagging overuse
injuries, or a direct referral from another practitioner who has assessed you, but can’t write scripts (i.e. your lactation consultant who’s identified some tethered oral tissues or body tension and has worked with you but needs another set of eyes and hands). But you can rest assured that a direct access PT (especially a DPT) has training and education to know how to spot conditions that fall outside the scope of PT or that send up any red flags that warrant further testing or referral. I also highly recommend this approach for folks who are interested in a “well-check” - something that doesn’t really exist in traditional physical therapy because we can’t assign a diagnosis code to that, so how do we get an insurer to cover it? If you’re the type of person who prefers more holistic wellness care, concierge-type therapy is great for helping you identify movement pattern asymmetries or deficits, postural deviations or ergonomic pitfalls, gait and balance deficits… the list goes on.
Quality > Quantity
In many busy clinics, PTs are often scheduling multiple patients in an hour. This DOES NOT mean that they're providing lower quality care! I did not provide any lower quality care than I do now back when I was seeing 2-4 patients an hour (with the help of some of the most stellar aides), and I have worked in super busy clinics with some of the best PTs around. Still, it's not typical for them to be able to spend a full session 1:1 with just you. But, if your preference is maximizing the time spent on your PT session while minimizing the number of visits you need in order to reach your goals, then in-home personalized care might be right for you! And, it cuts out a lot of the logistical stuff like traveling to and from, scheduling around childcare, etc. The money you spend might just well be worth the time you'll save!
You're Worth The Investment
Rising insurance costs mean YOU end up spending more on your care. Consider the fact that many employers offer low-premium, high-deductible plans and that many opt for those plans considering their health status and how often they estimate they would need care. Then when they need to use their insurance, they’re often surprised to find that they’ll have to pay for the first several PT visits out of pocket entirely in order to meet their deductible. This puts the provider in a difficult position. They cannot estimate your cost ahead of time, because they won’t know which or how many codes they will bill until they see you. In this model, you have more control over that out of pocket expense because you'll know my session fee up front, you can budget accordingly, and together we can decide a treatment frequency that works best for you. And you can still use the money that you allot for your healthcare by paying for services with your HSA/FSA, or you could submit to your insurance and seek reimbursement. (If you go this route, I recommend verifying your benefits ahead of time, securing any precerts or referrals needed, etc. I plan to put out an insurance benefits verification template for anyone who plans to seek reimbursement. I also provide a copy of your evaluation report complete with codes, and upon request, superbills.)
If your preference is maximizing the time spent on your PT session while minimizing the number of visits you need in order to reach your goals, then in-home personalized care might be right for you! And, it cuts out a lot of the logistical stuff like traveling to and from, scheduling around childcare, etc. The money you spend might just well be worth the time you'll save!
No, a cash-based PT won’t help you touch your toes any easier than any other PT. I am talking about the flexibility and freedom to work with you outside of the many restrictions of insurance regulations. Insurance regulations are important for many reasons, but if you consider who they benefit MOST, it’s usually not you. Consider how much money you pay for insurance each year, and yet, they can arbitrarily place strict limits on the number of visits your clinician (who has evaluated you and made a recommendation based on your individual needs and their previous experience in treating this condition combined with any other factors which might impact your care)
can see you for. This is incredibly frustrating for everyone involved. This is just one example. Some insurances limit the number of conditions that can be treated and billed per session, or the number and types of procedures your PT can perform within a visit. Often the physician will order a procedure, and then the PT will be the one finding out it is not covered by insurance and the patient will have to pay out of pocket anyway (surprise!). My goal is again, to put you in control of your healthcare, no surprises, no misunderstandings. I can not promise results, but I can promise flexibility, the willingness to go along with you on your journey toward better health and function, and I promise to give you as many tools as possible to help you succeed.
I would be remiss if I didn’t talk about who wouldn’t, or perhaps might assume they can’t, benefit from cash-based PT care. If you had become injured at work or in an accident, you might be restricted in the provider you must see in order for your claims to be covered in full or for legal purposes. If you have Medicare, in many cases, you cannot pay out of pocket for services that would normally be covered by Medicare (there are lots of rules surrounding this and I can post separately about it). If you need traditional homecare, private PT might not be best, as often folks who are truly homebound and need homecare PT often need or benefit from additional disciplines such as OT, nursing and/or speech or social work. I can recommend some great home health
agencies I've worked for, if that's what you need. And most importantly, I recognize that this model may not be equitable with respect to the delivery and reach of healthcare services, a problem that is already so impactful in a negative way to many communities in the US, and to which I do not want to further contribute. I am actively working on a plan to make my services equitable and accessible to those communities or individuals who might experience financial hardship or be otherwise impacted by the difficulties of our healthcare system in the “traditional” third party payor model. If you are concerned about how you will pay for therapy, reach out; we can work through it together.
It's worth the conversation to find out how cash-based PT could work for you. Let's talk!
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