Updated: Feb 16
I know you may be thinking "I pay health insurance monthly, and if I go with an out-of-network provider, I may not get reimbursed at all. Why would I even consider that?" Below we have listed some of our favorite reasons on why we believe cash pay physical therapy provides a higher quality of care.
Reason #1: One-on-one time with your physical therapist
Most insurance-based physical therapy clinics are jam-packed with more patients than physical therapist (PT), resulting in each PT seeing more than one patient at a time.
In a cash-based setting, there is no billing department required for reimbursement resulting in lower overhead.
Most insurance-based clinics are seeing a decline in reimbursements, resulting in PTs having to see more patients per hour to offset the difference.
In a cash-based setting, you have the attention of one physical therapist for the entire hour resulting in less visits needed due to the amount of work that can be accomplished.
Reason #2: No more being handed off to support staff
In a cash-based setting, there is no support staff that implements your plan of care. You work directly with your provider for the entire duration of your plan of care.
Continuity of care improves allowing for better outcomes in fewer visits
Reason #3: Insurance limitations
Many states recognize physical therapists as primary care providers, yet many insurance companies require a referral or authorization prior to initiating physical therapy.
As a result, insurance companies can dictate the plan of care.
Most insurances have visit limitations and specific metrics (often just subjective measures) that once reached, coverage is denied resulting in many patients not returning to their full capacity due to incomplete care.
Nowadays, most patients have high deductibles that have to be met before insurance companies cover expenses, meaning you still end up with out-of-pocket expenses.
With cash-based care, the physical therapist works for you not the insurance company allowing for collaborative care with the focus on making the best decisions for your health.
Reason #4: Frequency of visits
Insurance-based clinics often schedule at a frequency of two times per week for 4-6 weeks up to 12 weeks. This could result in 24 or more visits assuming your insurance company doesn't say "Sayonara!"
Due to the model of cash-based PT and the one-on-one attention, our clients typically need much fewer visits (6-10 over a 2-4 month window).
Reason #5: Holy modalities Batman!
How many sessions end with 15-20 minutes of passive modalities (after you have been handed off from your physical therapist)?
These modalities may feel good and help manipulate your symptoms, but they aren't actually doing anything for you and certainly won't fix what's going on.
In cash-based care, we do not use passive modalities as we view the time performing exercise, education and planning much more valuable to fix the root cause of the issue.
Reason #6: Proactive care or performance-based care
Most insurance companies do not cover any wellness visits for physical therapy like they would for your annual check-up with your physician.
It is less expensive to work proactively to mitigate the likelihood of an injury than it is to treat an injury once it occurs.
Think about all the regular maintenance you do for your house, vehicles, etc. Why do you not do that for your own body?
We could go on and on about the benefits of seeing a cash-based provider over the traditional model. Of course there are great providers that work in insurance-based clinics and many individuals see results in that setting.
If you are someone who has specific goals and values quality of care, the cash-based model may serve you better.
At Forge Physio, we decided to pass on the convenience of insurance contracts to pursue value based care for our clients over the bottom line of a billion dollar industry.
Ultimately, the choice is yours, and it comes down to what you value as an individual.