Why Cash-Based PT May Be Right For You
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)