Why Choose Cash Based Physical Therapy?
Updated: May 2
Insurance can be expensive and frustrating for both consumers & providers. When we pay a lot for insurance, we want to get something back in return. One of the first questions patients often ask is “Do you take insurance?”
With the ever changing health care landscape, many clinicians are moving towards the trend of cash based therapy (aka out-of-network with insurance companies). One big reason the cash pay model is so appealing is because it emphasizes quality patient care over quantity patient care, while removing the headaches and restrictions associated with insurance based care. In short, it is PATIENT FOCUSED. We wanted to take this opportunity to educate our community more on this model of therapy as it is on the forefront of our profession.
Our ultimate goal when opening BODY WORX Physical Therapy was to reinvent the traditional PT model, to get away from the dictatorship of insurance, and to change the way people view healthcare. We feel all patients should achieve 100% of their goals and function, but that does not always align with insurance goals & the traditional PT model.
The cash based model of PT in a nutshell entails the patient paying a flat fee per visit directly to the practice for rendered services. Once their treatment is complete the provider provides a "superbill," which is a paid invoice with the ICD-10 and CPT codes. This superbill can then be submitted by the patient to their insurance company for a direct reimbursement or to apply payments towards their deductible if it has not been met. This means that all that money you've been spending on health insurance is not a complete waste!
So what are the benefits to choosing cash-pay services?
1. Focused Care.
When seeing patients under a cash model, we as PT’s are not concerned about reimbursement and whether or not we are meeting the quotas of seeing a certain amount of patients to foot the bills, or filling out the right paperwork to get reimbursed, or patient medical forms to ensure they can have enough appointments to get well, etc. Patients get more one on one time directly with their Doctor of Physical Therapy, where we spend quality time helping people meet their specific goals and ultimately getting them healthier faster!
If you live in a mid-large size city, chances are you may have to wait to be seen in your typical in-network clinic. This could be due to both the availability of in-network clinics, having to see a physician first, and/or the amount of time it takes for your insurance provider to approve authorization to eval & treat. This can take up to 3-4 weeks in some cases. If pain has you sleepless or unable to do the things you love to do or even just daily activities, waiting around can be a daunting process. Once you access care through your insurance, there will be restrictions on visits and potential delay in care. This makes the rehab process even longer and more frustrating for both the patient and the clinician.
Not to mention, with payers out of the picture, PTs can truly focus on providing exceptional patient care rather than being distracted by the ongoing demands of insurance companies (like being on hold for 45 minutes before you can talk to a real human), just so their patients can have a fair shot at recovering.
3. Achieve Faster Results.
Patients sometimes don’t see the big picture when it comes to their care. This is not because of education, it's because of the hidden insurance regulations. Most practices will want to see the patient 2 to 3 times per week and with a copay average of $30.00 to $50.00 per visit that equals $90.00 -$150.00 per week. However, cashed based practices have the flexibility of scheduling the patient once per week for a longer session, providing high quality care and results in less time. So in reality, the $150.00 in copays is comparable to the price as one session with a PT at $150.00. The flaw with this method is the psychology of – if you see a PT three times a week you get more for your money versus one time. Wrong! Think of it this way, you see a PT three times a week for 8 weeks verses seeing a PT for four times in 4 weeks. Cash based practices focus on getting you healthy faster without having to jump through the nasty insurance hoops, with the perks of also saving you a ton of TIME! No need to use your PTO, miss work/school, or take away time from all the other things you enjoy doing in life!
4. Less restrictions on visit #.
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 PT services puts you at the helm of determining what kind of care you need, not your insurance company.
5. Shop local.
Going to a private cash-based clinic offers you the opportunity to support the local economy. As a local cash-based clinic, we are not outsourcing jobs. We are not a part of a big franchise. We are here to help the community in any way possible and are likely to support other small businesses as well! (email firstname.lastname@example.org for community involvement inquiries!)
6. Does your PT even lift? Or play sports? You have the autonomy to choose your provider! If you’re an active person, you want a PT who understands the active lifestyle. When you choose a clinic doing running, olympic lifting, CrossFit, or other sporting assessments make sure your PT really understands all aspect of the sport. Let’s say you injured myself when picking up a heavy piece of furniture and it’s now impairing your ability to do CrossFit or...(insert favorite exercise/sporting activity here). If you're going to hire someone to do a movement/pain assessment and treatment, you want them to understand not only the mechanics of my typical exercises, but the type of equipment you use, be able to demonstrate techniques or drills to improve your abilities, and even have other people within the local community they can recommend such as functional medicine providers, coaches, Chiro, gyms, etc. to compliment their services. Unless your PT has experience in many sports and the ENTIRE realm of fitness, they most likely won’t have those complimentary recommendations to their services.
7. What about HSA and FSA money? Can I submit cash-based services to my insurance for reimbursement?
YES! We accept both HSA and FSA funds as forms of payment. Don't let that money go to waste.
8. Can I submit cash-based services to my insurance for reimbursement?
Yes! Upon request, we can provide patients with a "superbill." A superbill is basically proof of payment that also contains all of the coding you would need to be reimbursed by your insurance company if you choose to self submit your claims. If you have not met your deductible, your payments can be applied towards your deductible which would help you meet it sooner. We highly encourage patients to check with their insurance provider first to see if they cover out-of-network services. Many times they will! We have had several patients receive full reimbursement for their PT after they submitted their superbills. This also applies to those who have insurance coverage through health share plans, such as Christian Healthshare Ministries. Many health share plans have GREAT PT benefits and have fully reimbursed our clients for PT services.
Our parting advice to consumers is to always assess your benefits of care under different clinics. We comparison shop most things in life, why not shop your PT & performance care too! You might just surprise yourself with what you learn.
If you still have questions, we have answers! Feel free to email us at email@example.com or call us at 325-261-0043 to see how we can help!
- Dr. Jodi, PT, DPT, CSCS
Dr. Jodi Hierholzer, PT, DPT, CSCS Doctor of Physical Therapy Owner/Founder of BODY WORX PT
Our mission at BWPT is to help athletes and active adults stay active by optimizing recovery, performance, and injury prevention. We also offer pelvic health therapy services. If you're ready to optimize your health and get back to doing the things you love without pain or limitations, we'd love to help! Give us a call or email us firstname.lastname@example.org.