It is no secret that the landscape of medicine in the United States is changing, and one of those major changes, is less and less practitioners taking insurance. This is no different for the Physical Therapy field. There is a major shift for physical therapists to stop accepting insurance, and to a cash based model. These physical therapists may go by a few different titles that you may have seen: Cash-Based, Out of Network, Concierge, Private Pay, Fee for Service, etc. As more of these types of offices pop up, you are probably wondering, what the benefit is for the patient? Well I will give you some answers here.
The first and possibly most important point, is Cash Based Physical Therapists usually treat their patients one-on-one. You as the patient, are paying for your time with the PT, and in turn the PT gives your their undivided attention. The PT session is about you and your needs, and there are not three other patients for the PT to be jumping around to, and being distracted by. This personalized attention can generally create improved outcomes in shorter periods of time. It also greatly improves the patient experience, and decreases medical errors.
Another reason to go to a Cash Based Physical Therapist is that you can meet your goals faster. In many states, there is direct access for physical therapy, meaning you can see you physical therapist without the need for a referral from an MD. Here in Florida, PTs can treat patients for 30 days without needing a referral. This is what the law states, but most insurance companies have decided to make their own rules, and have stipulated that they will not pay for PT sessions, unless there is a referral. Going to a cash based PT means that you can go the next day, or even same day as your injury, get evaluated and start being treated right away.
Cash Based Physical Therapists have the ability to treat how they believe will most benefit their patients, and not how the insurance companies dictate they should be treated. Some of my patients have greatly benefitted from educating them about inflammation, nutrition, relaxation and breathing techniques, or weight loss, but insurance would not pay for any of that. Cash Based PTs have a greater ability to treat the whole patient, not just what the insurance will pay for. Many insurance companies will only pay for what they deem necessary, and feel that things such as playing with your kids, playing golf, improving running form, or even PREVENTING injuries are not things to be covered by them.
The final reason, which may surprise you, is that seeing a Cash Based PT may actually save you money. As we stated before, Cash PTs tend to get you to meet your goals with less treatment sessions. Insurance terms and billing can be confusing, so this will best be explained with an example scenario. Let’s say a patient requires physical therapy for a specific condition, such as chronic back pain. The patient has a high deductible health insurance plan with a $3,000 deductible and a 20% co-insurance after the deductible is met. The cost of each physical therapy session is $150. The patient chooses to go to a cash-based physical therapist who charges $150 per session. They attend 10 sessions over the course of their treatment. In this scenario, the patient pays $1,500 out-of-pocket for the entire treatment. Alternatively, the patient could opt for an insurance-based physical therapist who accepts their insurance. However, they have to meet their $3,000 deductible before insurance coverage kicks in. In this scenario, the patient pays $3,300, which includes both out-of-pocket expenses before meeting the deductible and co-insurance after meeting the deductible. In this example, the cash-based physical therapy option is less expensive for the patient because they do not have to meet a high deductible before receiving coverage. This highlights a situation where cash-based physical therapy can be more cost-effective compared to insurance-based therapy, especially for individuals with high deductible health plans.
There are many reasons why seeing a Cash Based Physical Therapist may be beneficial for you, but it certainly is not for everyone, and you have to do what you feel most comfortable with. If you do choose to go to a Cash Based Physical Therapist, you may enjoy greater attention, improved and faster outcomes, better patient experience, and even end up saving money. Keep the old adage in mind: You get what you pay for. If you have further questions, feel free to reach out to me at [email protected]