Cash Based Physical Therapy: What You're Actually Paying For
Have you ever been to a physical therapy assessment and felt like your concerns were not fully addressed? Or have you ever been discharged from a physical therapy plan of care and felt like you needed more?
Why Physical Therapy Can Feel Rushed
Like our healthcare system, the physical therapy system is set up for insurance companies and not physical therapists or patients. Insurance dictates what treatments therapists provide, how severe your injury must be in order to seek physical therapy, how long a plan of care can be, and how often you can be seen by a physical therapist.
What this typically looks like for physical therapists is a caseload of 20-30 patients per day, balancing 2-4 patients at one time. Because of how insurance reimbursement works, these clinics hold their PTs to high productivity standards: a certain number of patients they must see per day and a certain number of units they must bill per patient. This is due to variable and inconsistent insurance reimbursement, which differs per state. Colorado’s insurance reimbursement, specifically, is rather low, contributing to higher productivity standards for insurance based physical therapists.
What This Means for Care
Due to these limitations, your appointment time will likely not be 1:1 with a skilled physical therapist, but rather shared among other patients. In many clinics, your time may be shared between a physical therapist and support staff including technicians, especially during exercise portions of your visit. While this model allows clinics to see more patients, it can sometimes limit the amount of one-on-one time you receive. In our experience, this type of care model can sometimes lead to longer plans of care, as progress may be more gradual when visits are shorter or less individualized. We often hear from patients that while they made progress, they were not fully ready to return to their baseline of activity after a course of physical therapy.
Hidden Costs
From a financial standpoint, in the insurance system, there is poor pay transparency and total costs aren’t always clear upfront. Some patients may receive additional bills weeks after starting care, depending on their deductible and coverage. Each visit, you must pay your co-pay, and in some cases, patients are sent additional surprise bills for physical therapy services, depending on coverage. Patients likely will not receive these surprise bills until several weeks into their plan of care. Co-pays may be as high as $90 and additional bills anywhere between hundreds and thousands of dollars, depending on the number of sessions. As a result, patients are forced to stop care that they did not budget for, and care is further fragmented.
Why Consider Cash Based Physical Therapy?
Many times, we get the question, “Why would I pay out of pocket for a physical therapist when my insurance covers it?”. At Summus Rehabilitation, we prioritize individualized care so that we may provide excellent outcomes to our patients in a time efficient manner. With a cash pay service, you can expect to have 60 minutes 1:1 with each appointment. With each session in the clinic, you can expect that your individualized needs will be addressed with the intention of guiding you towards your overall goals. This looks like the eyes and attention of a skilled physical therapist on you for 60 minutes.
We have found that with a cash pay model, patients recover faster, and are able to fully return to their goals after a course of physical therapy. Depending on your needs and our findings, care plans are anywhere between 6-8 weeks on the shorter end and 12-15 weeks on the longer end. Our visit prices are fixed, there are no surprise fees or bills, which helps our patients budget effectively for a plan of care.
If you have insurance, these costs go towards your out of network deductible. If you need, we can also provide you with a superbill, an itemized receipt with specific codes, for each visit. Your insurance can then reimburse you as per your out of network benefits.
Is a Cash Practice Right for You?
This does not necessarily mean that the cash pay model is “better” than the insurance model. It is simply different and meets different needs. Physical therapy within an insurance model can allow people access to care and many people recover within the insurance model. The insurance model may be a better fit if your activity demands or symptom burden is not very high. Typically within insurance-based care, your plan will be geared towards symptom management with a longer care plan duration.
A cash pay model allows for a slower pace of care, it allows individualized attention from a physical therapist, and targeted interventions geared towards your goals. It may be a great fit for you if you have higher activity demands, value a whole body approach, and prioritize individualized care. If you are curious to learn about physical therapy within a cash-pay model, schedule a phone call with us!
Written by: Dr. Isha Kelkar PT, DPT