Why Seeing a Cash-Based Physical Therapist is Better
By Dr. Ashley O'Rourke PT, DPT, ATC, LAT
Look, let’s just be honest - you’re probably hesitant to go to a physical therapist that is not in-network with your insurance company...and we don’t blame you. After all, you pay good money for health insurance! It would make sense to want to use a service you already pay for.
But does it really make sense? Do we need to use insurance for everything? Should we?
The simple answer when it comes to physical therapy is NO. Generally speaking, you will get more for your money by paying cash, and in a lot of cases it will actually SAVE you money. Keep reading and we will show you exactly how that is the case by doing the math. But first:
What is Cash-Based Physical Therapy?
In a cash-based treatment model, the physical therapist enters into a contract with the patient to provide physical therapy services in a manner that both parties have determined will help them reach treatment goals most efficiently. The patient pays a predetermined amount at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. You may pay for services using actual cash, a check, or a credit/debit card. You may also use FSA/HSA cards. Think of it as the same way services are rendered for a massage therapist or personal training.
Typically, coding for physical therapy services provided (CPT codes), is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their provider. Documentation for evaluations, treatment visits, and progress notes are performed just like any other physical therapy practice and comply with all legal requirements.
What does it mean to be an out-of-network provider?
This simply means that the therapist has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. There are MANY insurance companies, each with their own contracted rates and regulations, and cash-based therapists believe their energy is best spent working with patients. It is important to note that in-network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.
Is it possible for my insurance company to reimburse me?
Possibly! It is possible for insurance companies to reimburse patients depending on the individual provider and plan. There is no guarantee that your insurance company will reimburse you for the services, however, the cash-based clinic can provide you with the paperwork necessary to submit your claim. It is the patient's responsibility to do so and also to provide payment in full, up front, at the time services are rendered.
Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out-of-network". Going out-of-network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out-of-network in order to see the physical therapist of their choice. In the case of cash-based services, it is the patient who is waiting for reimbursement rather than the provider.