Insurance can be expensive and frustrating for both consumers & providers. When we pay a lot for insurance, we want to get something back in return. And we want something good in return. Is that too much to ask?
Unfortunately good insurance does not mean you will get good medical care.
I absolutely love my job but after working for 10 years at an in-network facility, the amount of instances patients were denied services, or their treatment was delayed due to paperwork and insurance hang-ups is astronomical. Over the years, reimbursement for therapy services has gotten less and less, which has backed most, if not all, in-network facilities into a corner. They are required to see more and more patients per therapist each day just to make ends meet. If you have ever been to an in-network facility before, maybe a few of these forced practices sound familiar:
2-3 (if not more) patients at a time per therapist
Limited time working with your therapist
Exercise/drills supervised by therapy techs/assistants
Multiple modalities (ice, heat, e-stim, ultrasound) performed each visit (and billed for all)
Multiple treatments per week
After 10 years I was burnt out and started to lose faith in my profession. So…my ultimate goal when opening Core Values Physical Therapy was to reinvent the traditional PT model, to get away from the dictatorship of insurance, and to change the way people view healthcare. We feel all patients should achieve 100% of their goals and function, but that does not always align with insurance goals & the traditional PT model.
With the ever changing health care landscape, many clinicians are moving towards the trend of cash based therapy (aka out-of-network with insurance companies). One big reason the cash pay model is so appealing is because it emphasizes quality patient care over quantity patient care, while removing the headaches and restrictions associated with insurance based care. In short, it is PATIENT FOCUSED. Your goals, your needs and your injuries are the only things that influence our care for you.
We believe firmly in the following ideas that are foundational to Core Values Physical Therapy:
We believe that every manual technique, corrective exercise, and drill given requires the eyes and mind of a doctorally trained therapist and not some high school kid working a summer job.
We believe that if patients are owners of their bodies and take their treatment seriously, 2-3x/week visits (can be) overkill and unnecessary. Discharge rates and visits used are almost half at Core Values compared to others due to increased one on one time with patients and patient-specific home exercise programs.
We believe that not being able to run or having shoulder pain in a pull-up are major problems when it comes to quality of life. Some insurance companies deem this “not medically necessary” and deny coverage. We are able to bridge the gap between the medical side of physical therapy and the performance side
We believe in evidence-based practice and research. Each exercise issued and modality utilized will be specifically chosen to help you meet your goals, saving you time and money in the long run.
We believe in giving you the autonomy to take care of your own body. You should not be reliant on a medical provider for life and we will get you independent as quickly as possible.
With that being said, we wanted to take this opportunity to educate our community on this model of therapy since it truly supports our core values that we listed above.
The cash based model of PT in a nutshell entails the patient paying a flat fee per visit directly to the practice for rendered services. Once their treatment is complete the provider provides a “superbill,” which is a paid invoice with the ICD-10 and CPT codes. This superbill can then be submitted by the patient to their insurance company for a direct reimbursement or to apply payments towards their deductible if it has not been met. This means that all that money you’ve been spending on health insurance is not a complete waste!
So what are the benefits to choosing cash-pay services?
1. Individualized and Focused Care.
When seeing patients under a cash model, we as PT’s are not concerned about reimbursement and whether or not we are meeting the quotas of seeing a certain amount of patients to foot the bills, or filling out the right paperwork to get reimbursed, or patient medical forms to ensure they can have enough appointments to get well, etc.
Patients get one-on-one time directly with their Doctor of Physical Therapy for their entire session, where we spend quality time helping people meet their specific goals and ultimately get them healthier faster!
Florida is a direct access state. You can come directly to your physical therapist without having to see a primary care physician for a referral, which can be time consuming and expensive. If you live in a mid-large size city, chances are you may have to wait to be seen in your typical in-network clinic. This could be due to both the availability of in-network clinics, having to see a physician first, and/or the amount of time it takes for your insurance provider to approve authorization to eval & treat. This can take up to 3-4 weeks in some cases. If pain makes you sleepless or unable to do the things you love to do or even just daily activities, waiting around can be a daunting process. Once you access care through your insurance, there will be restrictions on visits and potential delay in care. This makes the rehab process even longer and more frustrating for both the patient and the clinician.
3. Faster Results.
Patients sometimes don’t see the big picture when it comes to their care. This is not because of education, it’s because of the hidden insurance regulations. Most practices will want to see the patient 2 to 3 times per week and with a copay average of $30.00 to $50.00 per visit that equals $90.00 -$150.00 per week. However, cashed based practices have the flexibility of scheduling the patient once per week for a longer session, providing high quality care and results in less time. So in reality, the $150.00 in copays is comparable to the price as one session with a PT at $180.00. The flaw with this method is the psychology of – if you see a PT three times a week you get more for your money versus one time. Wrong! Think of it this way, you see a PT three times a week for 8 weeks versus seeing a PT for four times in 4 weeks. Cash based practices focus on getting you healthy faster without having to jump through the nasty insurance hoops, with the perks of also saving you a ton of TIME! No need to use your PTO, miss work/school, or take away time from all the other things you enjoy doing in life!
4. No restrictions on number of visits
When you use your insurance, you may only be approved for a few visits. What if you are going to need more visits or a longer window of treatment and your insurance won’t cover it? Paying cash for your PT services puts you and your PT at the helm of determining what kind of care and for what length you need, not your insurance company.
5. Supporting locally owned businesses
Going to a private cash-based clinic offers you the opportunity to support the local economy. As a local cash-based clinic, we are not outsourcing jobs. We are not a part of a big franchise. We are here to help the community in any way possible and are likely to support other small businesses as well! We run with the local run club, lift with the local crossfit gyms and are active members of the Lake Nona Chamber of Commerce.
6. You get to work with a medical provider who lifts and runs!
When you choose cash-based you have the autonomy to choose your provider! If you’re an active person, you want a PT who understands active lifestyles. When you hurt yourself running you want someone who deeply understands the ins and outs of running including your training, mechanics and shoe selection for example. If you hurt your shoulder doing a snatch and your PT does not know what a snatch is…how are you going to get back to your full potential or baseline, or even make sure your technique is correct so you don’t hurt yourself again in the future? If you’re going to hire someone to do a movement/pain assessment and treatment, you want them to understand not only the mechanics of your typical exercises, but the type of equipment you use, be able to demonstrate techniques or drills to improve your abilities, and even have other people within the local community they can recommend such as functional medicine providers, coaches, Chiro, gyms, etc. to compliment their services. Unless your PT has experience in many sports and the ENTIRE realm of fitness, they most likely won’t have those complimentary recommendations to their services.
7. You can use your HSA and FSA for payment.
Don’t let that money go to waste!
8. You can still submit for reimbursement with your insurance company.
Upon request, we can provide patients with a “superbill.” A superbill is basically proof of payment that also contains all of the coding you would need to be reimbursed by your insurance company if you choose to self submit your claims. If you have not met your deductible, your payments can be applied towards your deductible which would help you meet it sooner.
We highly encourage patients to check with their insurance provider first to see if they cover out-of-network services.
Many times they will! We have had several patients receive full reimbursement for their PT after they submitted their superbills. This also applies to those who have insurance coverage through health share plans, such as Christian Healthshare Ministries. Many health share plans have GREAT PT benefits and have fully reimbursed our clients for PT services.
Our parting advice to consumers is to always assess your benefits of care under different clinics. We comparison shop most things in life, why not shop your PT & performance care too! You might just surprise yourself with what you learn.
If you still have questions, we have answers! Feel free to email us at email@example.com
or call us at 407-476-6613 to see how we can help!
Thanks to PeakRX and BodyWorx PT for the content assistance!
-Dr. Rebecca Smith, PT, DPT