By: Dr. Trey Larant PT, DPT
"Why would I pay cash for physical therapy if I have insurance?"
This is probably the most frequent question/concern I hear from potential patients when discussing our business model at Evergreen Wellness Co. But why would I pay cash for physical therapy when I already pay for health insurance? The problem herein, lies with the entire American health insurance system…
I am going to use my past personal health insurance as an example. I previously had an employer-sponsored health insurance plan. I thought it was pretty good by all standards. No cost to me to have the plan as an individual. $750 deductible, $7100 out of pocket maximum, $50 copay, and 20% coinsurance.
Now what the heck do all these numbers mean? Let’s take my last surgical experience. It involved having a full-thickness skin graft taken from my entire forearm, leaving me in a cast for a month with significant wound care needs and severe lack of motion in my wrist. I needed physical therapy.
I was given 6 visits at the local clinic. I had already met my $750 deductible having paid it towards the surgical fees. Then insurance kicks in and pays 80% of each visit, meaning I have to pay the remaining 20%, on top of my $50 copay. The average cost per physical therapy visit is $150. Now 20% of $150 is $30.
This means every session costs me approximately $80 with my insurance.
Things to keep in mind:
#1 - What am I actually paying for?
What am I actually getting for my $80? With insurance companies reimbursing clinics less and less each year for services, that means employees are expected to see more patients per hour. Meaning you might see the actual physical therapist for 10-15 minutes, before they have to rush off to their next person. So, in reality you are paying $80 for 15 minutes of care by a professional, with maybe some help from an aide.
#2 - What if my insurance doesn't have great coverage?
I’ve had patients with copays as high as $75 per session, deductibles surpassing $10,000, 50% coinsurances, etc. This means even though you are billing insurance, the cost per visit is much higher, for the same 10-15 minutes of care. You could even SAVE money by cash paying for physical therapy instead of billing your insurance.
#3 - What if I want to prevent injury?
Insurance does not treat prevention, maintenance, or high-functioning individuals. Remember those 6 visits of therapy I was authorized after my surgery? Well, that is all I got. 6 visits. I, as a physical therapist, was told I didn’t deserve any more physical therapy because my arm at 2 months post-op “was as good as it was ever going to get.” Mind you, at this time my arm was still bloody and being burned with silver nitrate and debrided 1-2x per week. So that is B.S. My arm was clearly not done healing. And I was left to figure out how to treat my wounds myself.
What if I didn’t have any medical training? What if I didn’t have any support at home? Insurance didn’t care. I have been told so many similar things by insurance companies for my various patients over the years. Told that running wasn’t functional for a 12-year-old, so they didn’t need any more physical therapy. Told that my high school baseball pitcher could feed himself, so he clearly didn’t need any more visits. Told that my patient with a recent rotator cuff repair and still in a sling didn’t need any more therapy because the average visits needed to fix a shoulder was 8.
Why you need to start paying cash for physical therapy
When I branched out and started my own clinic the choice was quite obvious. I was not going to take insurance. I was not going to sit on the phone for hours every day fighting to get my patients the coverage they clearly deserve while people with no medical training get to decide what is best for them.
So, for many people, hearing that it costs $130 for each physical therapy visit with Evergreen Wellness seems like a lot of money. But what I am giving you is the time, dedication, and individualized treatment you deserve. Every appointment is 1-on-1 for an hour.
You don’t need to wait for a referral from a primary care doctor to be seen. And YOU decide when and why and how often YOU need treatment. We work towards the goals YOU have. Not what insurance thinks you deserve.
Take advantage of individualized care through cash pay
Save yourself time and money by choosing to get care at a cash pay practice such as Evergreen Wellness Co.
Have questions about what you would actually pay for physical therapy with your insurance? Use this form and call an insurance representative to receive details on your insurance plan and if you will get reimbursed for cash pay services.
Don't want to deal with the hassle of insurance? Call or go online to book an appointment today. No referral or insurance needed.
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