top of page
  • Writer's pictureErienne Blanchard

Why you ought to see a cash-based Physical Therapist...

I have paid good money for insurance, and I want to use my benefits. Why don't you take my insurance?

people gathered around a table with one teaching the other how to fill out forms

Let's talk about most insurance companies and how they interact with your providers. As a provider, I have a contract with each and every one dictating how much of a fee schedule I receive for each unit of treatment. Meaning if you are in the clinic for an hour, I would receive 4 units of pay. Depending on the unit, the cost is different and whether or not we used more than one of the same code. Looks like this.

  • 97140 (manual therapy): $22 but your practitioner was only able to negotiate 85% of that (so they only receive $18.70) for the one code ~15 min of treatment.

  • Let's say you used two of those codes for 30 min of manual therapy (hands on treatment). They deduct another percentage usually only receiving about 80% of the first amount (now getting $14.96 for the second code of the same thing).

  • The remaining 30 min may be split between two other codes (exercise and activity) on average $18.70 and $18.70.

  • Total visit reimbursement for the visit: $71.06

  • The company also deducts your copay from this amount...meaning if you are responsible for a $35 dollar copay, your insurance will pay us the remainder $36.06.

A man helping another man with an exercise of the arm overhead. The patient has a hand weight over his head and is working on extending his elbow without moving his shoulder.

This is for an hour of a Doctor of Physical Therapy's (DPT) time with you to help you get better. We struggle with these reimbursement rates because they don't meet inflation and budget needs with the amount of collections and paperwork this requires. The lack of reimbursement reduces the time the Doctor can spend with you to make clinic finances. Therefore, you only get about 30 min with the DPT and are usually given to an exercise specialist to continue the treatment. This prolongs treatment because you have lost focused care on your form, time to create and give specific exercises for your areas of weakness or coordination, and a therapist who is burned out due to the high patient load with little satisfaction. Even when we are more specific, it becomes more wrote in order to meet time constraints.

Let's get back to why cash-based/ out of network. When you pay the cash rate at a clinic that is not taking insurance, you are guaranteeing focused treatment on your needs and wants and not what insurance says you need.

  • Insurance requires referrals by physicians (most of the time) to pay

  • Insurance requires that I stay within the confines of a specific referred region (only neck, only shoulder, etc)

  • Insurance requires that I only use so many visits (but not enough true time means longer treatment duration- instead of 6 visits now you may need 12-16).

  • Insurance requires that perhaps you only have 20 visits for that region in your lifetime (some plans do this) or only allowed to have treatment for a specific diagnosis for 20 visits in your lifetime

  • Insurance doesn't let me treat you for sports return because that is not considered part of your functional daily needs

I chose out of network in order to meet your needs and wants without us having to confine your

treatment. You come in for neck and face pain. Jaw pain or TMJ is a policy that has to be added in some cases and more insurances companies are not covering it. I can be a part of you getting back to eating, speaking, and sleeping well. Perhaps you also come with some low back pain, I can treat that too while we are working on the face.

  • Out of Network means we decide what you need and what treatment is best

  • Manual therapy, manipulation, dry needling, exercise, and education

  • Increased time to listen without quickly moving you along

  • Availability to your Doctor of Physical Therapy with texting, portal, and exercise portal

  • Televisits as needed

Entering a credit card payment into the system for a cash payment at physical therapy

Out of network lets me be the Doctor of Physical Therapy that you

as a patient needs in order to maximize your progress, change the exercises specifically to the tasks and activities you want to accomplish, and improve your daily life with less visits. I can be available to you when you need it and be able to address your needs more readily in a more personalized care plan.

Why out of network? Because I can be what you need without pressure from other third-parties to do therapy their way when they don't really know you or your needs. You are the priority in my care not your insurance company.

37 views0 comments


bottom of page