It’s question I get a lot and my answer is: I am an out of network provider for all insurances, so NO, I don’t bill insurance. Here’s another question I get--Why should I go to you and pay out of my pocket when Clinic X takes my insurance? I have multiple answers, but let’s start with the money issue.
If you have a deductible or co insurance, you already are a cash paying patient, regardless of where you go, until you meet it. Think about it, if you have a $5000 deductible and the clinic has a relationship with an insurance where the contracted amount negotiated for reimbursement is $80, you are responsible for that $80 each visit until you reach your deductible. And when was the last time you reached your deductible consistently?
Now, on to my second answer: We’ve established that you have to pay $80/visit. How long is your visit with the actual PT who is responsible for your plan of care and has gone through the education and has the experience you want? With my treatments, you are with me for a full hour 1:1 with an expert. I spend more time with you and addressing your specific needs as an individual without any other patients present. Having this 1:1 time allows me to assess and customize your treatment which allows me to see you less frequently. So, to answer the question---I want to give my patient’s the time they need each visit, not what insurance dictates I can do.
Most of my clients go to a gym and are actually really consistent about going. Why would I want to see you 2-3x wk , if you can do what I’ve instructed on your own? That’s a business model, not a PT model. Healing and adaptive changes take time. Being seen 1x/wk allows me continue to assess the changes and advancements you need and ultimately saves you money and time in the long run.
What are some other benefits of not taking insurance?
I can treat any body part. With insurance based models you are assigned codes to your injury and PT’s are required to stick to those body parts or go through mounds of paperwork to show why you are changing. Coming to me, I can work on anything at any time giving you treatment you need, not what the insurance company says I can treat.
I can treat you for a longer period of time. Most insurances either have a visit limit or date you must use your visits in. These don’t take into consideration healing times, timelines for consistent adaptive neuromuscular changes, and LIFE. sometimes life gets in the way and we need to take some time for yourself.
I have been a PT for over 20 years. NO ONE gets into healthcare to be rich. I enjoy helping people achieve their goals. Nothing makes me happier than when I get an email from a client that they could walk at Disney, finally drive without pain, or reach a PR on a lift without pain. This model of PT allows me to put you first and not consider the restrictions insurance puts on us.
