Why Cash based?
As both a clinician and a previous manager of a larger physical therapy clinic, I saw the challenges the industry faces first hand over the last 8 years. Year after year insurance companies cut reimbursement for physical therapy services while the cost of salaries, rent, utilities and supplies all increased causing traditional clinics to make very hard decisions. I saw the denials for absolutely necessary patient care resulting in very large surprise bills in the mail for patients months later when the insurance company deemed the services went beyond what they are willing to cover. In addition, I've seen the incredible compromise in the industry- double, triple, and at times quadruple booking therapists to drive their productivity and profitability standards while completely compromising on patient care. When moving to Boston, I made the decision not to return to a traditional role and made the very hard decision not to participate with insurance companies as to not compromise the time I spend with my patients and the high quality of care I provide at a rate that reflects my years of experience, advanced trainings, certifications, education, and results allowing my patients to feel maximally supported and cared for in an environment that allows them to achieve real breakthrough in areas they never thought possible.
Can I utilize insurance at all?
Yes! If your insurance plan offers out of network benefits, after paying for your services you can be provided with a superbill to submit to your insurance company directly. Also, you are able to utilize FHA and FSA funds towards my treatments.
What are the benefits of not utilizing insurance?
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Faster results - a study conducted in 2013 found that on average patients utilizing cash based therapy services required less appointments to see results because of the individualized care provided by this model of therapy
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Because of this, cash based services could actually be less of a financial commitment, especially if you are operating under a high deductable insurance plan where you would be paying for your services out of pocket likely months after the services cease, without knowing the final cost up front
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You will always be 1:1 with your therapist, never transitioned to an aide or an assistant. The therapist who conducts your initial evaluation will be the same therapist you see through every single appointment and beyond
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You have access to your therapist via email between sessions for continued support towards your goals and there is time within each session to film videos and cover exercises for optimal results at home
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Cost transparency - you know EXACTLY how much your services will cost, no surprise bills months down the line and no guessing.
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You are treated within a pilates studio blending the benefits of pilates based exercises with traditional physical therapy methods for maximal results
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Knowing your therapist is selecting the BEST treatments for you and your specific recovery without catering to the needs of a third party payer - trusting the services provided are the best fit for the patient at hand
What are some of the common issues seen with the traditional insurance based model?
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The client doesn't know how much they are paying for services until the insurance company sends a bill which often comes as a surprise months down the line
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For a number of reasons, the insurance company could retrospectively deem the services not medically necessary the entire POC could be denied and you receive an even larger surprise bill months down the road
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Whether you know it or not, insurance companies are the determining factor behind the scenes of modern medicine more than you may think- for instance, manual therapy reimburses only half the price per unit as some exercise based modalities. However, based on my experience both are of EQUAL value depending upon what the patient needs at that time... but because of the pressure to earn the clinic money an "in network therapist" may be forced to make decisions they wouldn't make otherwise to choose profitability over true care and expertise
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Visit caps imposed by insurance companies - an insurance company will dictate how many sessions you receive and at the end of the allotted visits they will no longer pay even if you have yet to see the recovery or breakthrough you were hoping to see
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Unfortunately the trend is moving towards spending only ~15 minutes with your licensed therapist and the rest of the time with an aide. If your copay is $50/session but you spend only 15 minutes with your PT that means you are valuing his or her time at $200/hour, though it would take you 4 sessions to even total an hour of 1 on 1 care with the clinician with the degrees and expertise.
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The person conducting most of your care? Most likely a high school or college student with a big heart and big dreams and goals to be a PT someday (as I was when I worked the role of PT aide throughout my undergraduate years), but unfortunately unable to deliver the skills you need now to get better fast.
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That being said - are all clinics accepting insurance the bad guys?
Absolutely NOT! In fact, a lot of these clinics are filled with PTs who truly want to make a difference in the lives of their patients and it's the system that actually hinders them from doing so. Nobody goes to PT school with dreams of treating four patients at a time, but decisions are made because people have families, student loans, bills to pay and an ever rising cost of living. I understand cash based services are not for everyone and I am grateful that insurance based clinics exist so everyone can receive some level and access to very necessary services. It's not any PT's fault if they are at a clinic that does not allow them the time or opportunity to care for their patients in a way that actually serves them- it's a failure of the system. That being said, not all clinics who accept insurance offer subpar quality care, some work very hard to do everything they can to comply with the demands of the insurance based model and still strive to offer the highest quality of care possible, but unfortunately, because of the structure of the system those clinics are too few and far between and seem to be disappearing more and more year after year.