Is Cash Pay Worth It? Part 2

The Cost/Benefit Analysis

A decade ago I had a hip injury and found myself needing to see a PT. I really wanted to work with one of my former PT school professors, but as a small boutique practice, she was “out-of-network.” To see her, I had to be ready to pay out of pocket for everything. At the time I was working on paying off my student loans and pregnant with my first child so money was a huge consideration but, having worked in many different clinics, I had a unique perspective on what a wise investment into my recovery would look like. As a PT needing PT, I knew that paying out-of-pocket for quality care from a skilled practitioner I trusted was going to be a more efficient use of my time and money. So I prepared to pay cash.

Let’s imagine I had chosen the clinic down the street that would be fully covered by my insurance but was using the strategies we talked about in part one to make their money. For the first 15 minutes, my assigned PT might provide skilled hands-on treatments like joint mobilizations to improve my flexibility, but then hands me off to an aide for 15 minutes of generic strengthening exercises. If one of those exercises was painful, the odds of my aide knowing how to modify it or select an appropriate replacement would be slim. For the next 15 minutes my aide uses an ultrasound machine to “warm my tissues and promote healing,” even though there's practically zero literature to support it's efficacy. Finally, they give me ice, which is a very effective treatment but requires zero attention from even the aide. If we look at the numbers, my insurance may be billed for up to an hour's worth of treatment, but only ¼ of that treatment was skilled intervention from the PT. This is kinda the worst case scenario, but sadly not altogether uncommon. 

Contrast that with my actual experience paying cash for guaranteed one-on-one care with a licensed PT. For the entirety of every visit, the care she provided was specifically tailored to meet my needs. We did lots of manual treatments, and if one treatment wasn’t as effective as we hoped, she had time to adjust, get me back on the treatment table, and find what worked best. Exercises were designed specifically to teach my body how to move in ways that would protect my hip and prepare me to return to activities that were meaningful to me. We never felt rushed. She spent time reviewing my MRI images with me and always answered questions I had about my progress. Every clinical decision she made was unbiased and in my best interest. The most amazing part…I went from walking with crutches to running in just 6 visits. A decade later, I’m still able to use the strategies she taught me to right the ship if my hip starts to feel a bit cranky.

In my experience, the quality of your PT experience matters, and there was a clear reason I chose to pay cash. But I know many of you may still be on the fence and wondering why you would pay out-of-pocket when you’re already paying a ton for the privilege of billing your insurance. So let's crunch some numbers and consider a few scenarios where even if you have insurance you might actually save in the long run by paying cash. (Keep in mind these are hypothetical examples that I hope can provide a framework for thinking about the true cost of your healthcare. Everybody's policies are different and it’s important to know what your own insurance will pay for.)

Scenario 1: 

Your insurance covers PT treatment, but each visit comes with a $50 copay. If we estimate your recovery will require 4 total hours of personalized PT care, here’s how that will look after completing care with…

A.) A High Turnover Clinic: Your $50 copay might buy you 15 minutes with your physical therapist. To reach that 4 hour mark, you’d likely need to return for a total of 16 visits. At $50 a pop, your out-of-pocket cost, with insurance covering the rest, is going total $800. 

B.) A cash pay practice with guaranteed one-on-one care: At 45 minutes each visit, you’d need 6 visits to surpass the 4 hour mark. At $100 a pop, your out-of-pocket cost after those 6 visits would total $600.

$600 is less than $800, so it seems that you’d actually save money at a cash-pay practice.  But also consider this…we’ve all heard that "time is money"…in this scenario you’ve also spent 12 fewer hours trying to fit PT visits into your busy schedule. Saving time AND money is a win-win on your journey to feeling better. But if you’re still feeling skeptical and this scenario feels a bit extreme, let's look at…

Scenario 2:

Maybe your copay is only $25. That would drop your out-of-pocket cost to $400 total at a high turnover clinic compared to cash-pay at $600. So using insurance would save you $200, but you have that secondary calculation to make. How valuable is your time? Is it worth $200 extra dollars to save 12 hours of your life? Even with a $0 copay, for some people, the efficiency of care may be valuable enough to shell out the full $600.

Bottom line: It’s not just about the money. Choosing a PT who will help you meet your goals is also about prioritizing the efficiency and quality of care you are receiving for that money. If you can find a great clinic that is still able to take insurance and provide individualized care then great! But if you have a PT you want to work with and they’re “out-of-network,” it’s still almost always a sound investment. You’re investing in your wellbeing, likely getting better quicker, and that should count for something!

Money obviously still matters for most people. So get ready for part three where I talk through a few ways to potentially lessen your burden financially and recoup your costs if you’ve decided to see a provider that is not in network with your insurance.