This is one of the most frequently asked questions as it pertains to paying of PT services in non-conventional practices. I usually welcome the conversation because we as professionals have to do a better job at educating people on the options that they have available to them. I truly believe that nothing is a one size fits all. Just as the home/gym/office based mobile therapy option isn’t for everyone, neither is utilizing existing insurance coverage. We are conditioned to believe that insurance is the end-all be-all and it just isn’t. The short answer is, probably not and I'll explain why.
Using a cash-based /out of network model actually places more control in the hands of the client and the providers. There are literally hundreds of insurance plans with each having different tiers of coverage and what is allowed under their umbrella. Oftentimes, you have to call to determine if PT/OT/Speech is even covered in your policy and to what extent. It’s kind of like going into a store and being told you can only shop in the clearance section. I love a great deal, but if I’m getting last year's model and it doesn't quite fill my needs, is that the best option for me? It would be nice to have the ability to buy what I WANT even if it costs more. Sometimes, paying more for the same product also means higher quality or satisfaction. I hate it when I go cheap on something and end up paying more because I had to end up buying 2,3 or 4 because the product didn’t last. Additionally, insurance gets to dictate how much and what type of treatment you receive, not the trained professionals. We've all heard of people stopping therapy because "insurance ran out!"
So, who should consider Cash-pay options for PT?
*If you are uninsured: Most often, those without insurance will pay more from insurance based clinics because they cannot apply the large discount by working with insurers.
*Those with high deductibles: Patients will often pay just as much if not more per visit until in-network or out-of-network deductible is met. It would make sense to pay for the higher quality, convenient option in this scenario.
* Those with high co-pays and regular insurance: Let’s use a quick example to compare.
if a specialty office visit co-pay for PT is $40 /visit and your plan of care recommends 2-3 x /week x 4 weeks you would potentially be out of pocket $320 to $480 (in addition to your premium costs). Not to mention, depending on the clinic you may only see your therapist the first and last visit. You may see varying personnel or there may be heavy dependence on patient guided exercises, thus diminishing the quality of service and outcomes.
But, if you received more 1 on 1 time, access to resources, different techniques not covered or utilized by insurance based clinics and you could get the same results in fewer visits it may look like this: 1 x /week at $120 /visit over 4-5 visits= $480-$600. In addition to comparable costs, you are saving on things like time/effort to get to and from your clinic, gas mileage, additional child-care coverage if needed or taking time off of work to attend. Our cash-based model will also accept HSA/FSA card payments as well. It's your money, you should be able to spend it on the health care services of your choosing!
As you can see, Cash-based PT can be an affordable and preferred option for many people based on your specific needs. We can also verify if out of network services can be reimbursed by your insurance company. Check back in to find out how it works. If you have any additional questions feel free to contact us.
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