We pay a lot for our insurance. We want something back in return. However, using your insurance to cover your physical therapy services may not always be in your best interest. Here are some reasons to seek care out of your physical therapy network:
- Access to clinical care. If you live in a larger city, chances are you will need to wait to access PT. In a largely HMO dominated area, that wait could be as long as six to eight weeks. If pain has you sleepless or unable to do the things you love to do or even just daily activities, this is time to search for an alternative. Once you access care through your insurance, there will be restrictions on visits. Oh and don’t forget, any billing through your insurance means they have access to your notes. This could be a problem should you ever later have a similar injury related to an auto or workman’s compensation claim. Insurance may try to deny you treatment based on a prior existing condition.
- Past experience and/or continuing education. Many patients don’t take into account prior experience or training when they go to their insurance based PT. So when you have the choice of seeing the PT who does the minimum continuing education yearly versus the PT who attends multiple courses yearly, who would you pick? Most hospital systems barely cover the cost of one course for continuing education annually. Typically private practices offer many more training opportunities and PTs in the private sector seek out the most up to date care and information. It is also easier for private practice PT to have specialty services at their clinics as they do not need to go through multiple levels of approval to do so, unlike larger hospitals or clinics. Additionally, certifications quantify experts in various areas. So if the price of PT is comparable or slightly more, why not chose that expert? They will most likely get you on the road to recovery sooner! This will save you in the long run on time off of work attending visits, traveling to visits and monetarily.
- Total Cost of Care. If a cash based PT at $50/session gets you better in 4 visits ($200 total) and an insurance co-pay PT at $30/session gets you better in 8 visits ($240/total in co-pays), the cash based PT is actually less expensive in the long run, in both time and money. OR lets compare 8 visits at a $50 cash rate, $400 total, to 8 visits insurance co-pay rate of $30 for a total of $240. Well that $30 co-pay is what you see assuming every thing else gets covered by your insurance. Your insurance is really being billed hundreds/hourly, typically at least $350 so add another $2800 onto your total cost of care for a grand total of $3040. What does that do to your future insurance rates? Well it will most likely increase them. Or even better, what if your insurance denies payment, who gets stuck with that bill? You do. If I walk into a grocery store to buy a gallon of milk, I have to pay the price listed for it. If its $3, I can’t tell the store, “Today I feel like paying $1” and stick someone else with the $2 difference. Insurance, however, typically undercuts the amount billed leaving you responsible for the remainder of the bill. If I try to use my insurance to pay for my healthcare, there is no guarantee they will pay for it. I get stuck with whatever difference the company does not pay which is most likely going to be more expensive in the long run.
- Shop local. Going to a private cash based facility offers you the opportunity to support the local economy. Chances are with a cash based clinic, they are not outsourcing jobs. They are also more likely to support other local businesses.
- No rules. OK that may not be entirely true. We still have laws and regulations to abide by as PTs. But, when you use your insurance, you may only be approved a couple of visits. What if you are going to need more visits or a longer window of treatment and your insurance won’t cover it? Paying cash for your physical therapy services puts you at the helm of determining what kind of care you need, not your insurance company.
- Sports. It amazes me how many clinics claim to have services geared towards running, golf, throwing, swimming, biking, etc. However those PTs running those clinics don’t always participate in those sports. When you choose a clinic doing running, biking, skiing or other sporting assessments make sure your PT really understands all aspect of the sport. Why do most clinics do video analyses on treadmills? Do most runners train or race on treadmills? It makes no sense! Who cares if you get 200 frames/second in your camera that films treadmill running. This tells you nothing if it is not in your true running environment. Or let’s say, I’m going do hire someone to do a skiing assessment, I want them to understand not only the mechanics, but the evolution of equipment, be able to demonstrate techniques or drills to improve my abilities and even have other people within the local community they can recommend such as boot fitters, coaches, strength trainers, etc. to compliment their services. Unless they participate in that sport, they most likely won’t have those complimentary recommendations to their services.
So my advice to consumers and physical therapists alike is to assess your benefits of care under different clinics. We comparison shop most things in life, why not shop your wellness care too! You might just surprise yourself in what you learn.