Is Cash Pay Worth It? Part 1

Why more and more PTs wont take your insurance.

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It’s open enrollment season! Every year feels as if we’re asked to pay more for insurance policies that provide us with dwindling coverage and fewer in-network options. As the cost of healthcare continues to rise, you may have noticed that many providers are no longer in network with your insurance company or maybe aren’t accepting insurance at all. This is especially true amongst physical therapists, and there's a pretty logical reason for the seismic shift towards cash-pay practices. 

Here’s the rub. Insurance companies are notoriously stingy about reimbursing PTs. As reimbursements have fallen, our profession has had to find creative ways to submit more billing claims to simply keep the doors open. There are two main strategies I’ve seen utilized to accomplish that goal. First, PTs will hire aides (individuals the PT is responsible for supervising but otherwise require no licensing or formal training) so the PT can legally treat multiple patients at a time. This increases the number of claims submitted per hour to offset being paid less per claim. Secondly, as a result of needing to bill for treatments that can be administered by people without formal training, patients are sometimes administered treatments that really have no proven benefit or are less efficient because historically insurance will still pay for them. For example, that ultrasound treatment you received in the past has no clinically identifiable healing benefits for a majority of conditions, but because an aide can use the machine and insurance still pays for it, tada! It’s a part of your PT plan. 

As a notoriously altruistic profession, most PTs are very discouraged and fed up with the pressure to sacrifice our patient’s quality of care for our bottom line. Some PTs feel they have no choice but to stick it out with insurance companies and they do the best they can under the circumstances, but many of us have chosen to become “out-of-network” providers, or cash-pay clinics, because we’re just not ethically comfortable with the trade-offs we’ve been asked to make in order to keep the lights on. For me personally, being a cash-pay practice is the best way to ensure my professional autonomy and safeguard the quality of the care I believe each of my patients deserves. The decisions made about your care should be most influenced by your individual needs, not what insurance is willing to pay for. 

I hope in writing these posts about cash pay practices I can shed some light on this new trend, help you weigh whether it’s worth it to see a cash-based PT, and show you ways to recoup your out of pocket costs. Despite what it may feel like, cash based practices aren’t just grabbing for your money. We legitimately want to treat you well and dealing with insurance companies has made that really really difficult. So read on for part two! I’ll share why I as a PT chose to pay cash for my own hip injury rehab and why it might be a wise and possibly cheaper choice in the long run for you, even if you have insurance, to pay cash for all your physical therapy needs. Stay tuned!