By Dr. Jessica Warnecke PT, DPT, OCS
Over the past few years, there has been a consistent shift in the healthcare world for both us as citizens and also for our medical professionals. Insurance rates have increased, coverage options have decreased, and clarity of understanding your plan has been getting more confusing. There are in-network rates, out-of-network rates, high deductible plans, health savings accounts, co-pays…and the list goes on and on.
With these transitions, you’ve seen a greater shift of medical specialists actually choosing to forego insurance contracts and accept only cash forms of payment. Concierge physicians, independent chiropractors, and cash-pay physical therapist numbers are growing all around the country in both rural and urban communities.
But it makes sense.
For many years, lawyers, dentists, counselors, massage therapists, and psychologists have been successfully running businesses and offering pay for service fees--and there is good reason for that. Their services are important! They know this, we know this, and these professionals have done an excellent job of dictating the level of care they provide rather than allowing a third-party insurance to tell them how to work.
Most people have some form of insurance and expect to be able to utilize their plan benefits no matter where they go. However, most people don’t truly understand their benefits and can get stuck with an unwelcome surprise without warning.
So, what does being in-network really mean for physical therapy?
When a company is in-network, that means the insurance people control what the therapists can/can't do. They may limit how long we can treat, how often, how much, or what techniques we do. If they decide that something isn't "needed" and it has been done, they won't cover it and the patient finds out after the fact and is responsible for the bill. Keep in mind that these insurance people are business men/women sitting behind a desk that have no medical knowledge and shouldn't really be determining what is necessary or not, but that's what it has come down to recently with all the healthcare changes.
This is a big reason why many big corporate physical therapy clinics or “factory-run” centers can give our profession a bad rep. They have to try and overcome the crazy rules placed on it by the different insurance companies and figure out how to make a profit. Clinicians are regularly seeing 2-4 patients each hour, using unskilled treatments like ice and hot packs to fill time, and delegating exercise tasks to technicians who can’t fully know what the patient needs or how to adjust the exercises appropriately.
While the clinic itself may charge $150-350 each session, the insurance only pays the clinic a small portion of that fee so multiple patients/hour help to make up the difference. That correlates to only having 15-30 min with the doctor and having to share time with other patients each session. If you’re only getting a fraction of direct care with your specialist, then you will have to see that person multiple times each week for weeks to months at a time in order to make real progress and get back to where you want to be. This leads to over-worked therapists, under-whelmed patients, poor motivation, and often times a negative experience for the patient in regards to their health and PT.
What’s the difference with a cash-based physical therapist?
Well for starters, the level of care is on an incomparable level to an insurance-based company. The clinician is available for an entire one-on-one treatment session and not bouncing back and forth between 2-4 patients each hour. It also means you as the patient are being treated entirely by the doctor and not being run through exercises by a technician or sitting with an ice pack (all while being billed for that time). This allows your care to be entirely individualized to what YOUR body needs with manual and exercise treatments being altered depending on how you respond. Ultimately, this results in a quicker time to heal and helps you reach your goals in a shorter time frame for much less money.
You may be asking how a cash service can be more affordable than insurance? There are multiple answers to this question depending on what type of PT benefits your plan offers. Read HERE for common scenarios.
I could write for days on the varying rules of today’s current health insurance world and how it affects physical therapy, but I hope this has done a good job of opening your eyes to what is out there that you may not fully understand. I am not encouraging the public to waive health insurance altogether. There is a very important place for having insurance coverage for events like health emergencies, pregnancies, or unpredictable accidents.
However, being aware of what you are getting with your health insurance is so valuable. You want to understand all the fine print before signing for your house. You want to know the loan details before you buy your car. Take advantage of having the power to also recognize your healthcare and know that just because it may seem like the quality of care is diminishing doesn’t mean all hope is lost.
Meet Your Therapist
Jessica has been in Austin, TX for the past four years. She grew up in Idaho and attended PT school at Idaho State University. She completed an Orthopaedic Residency and became a Board Certified Orthopaedic Clinical Specialist in 2016.