Why pay cash or out of pocket from insurance for Physical Therapy? Every year more and more of our patients are paying cash out of their own pockets for our physical therapy services. Like most health care providers, we bill insurance companies as a service of convenience for our patients. In recent years, deductibles have climbed to $5000 or more, copays have become higher, and scrutiny by insurance companies over what is covered has increased. We are now at a point where many of our patients/clients have lower out-of-pocket expenses if they simply pay for our services without going through their insurance carrier.
Government regulators allow us to provide discounts if sessions are paid for by the patient on the day of service, with further discounts if they pay for multiple sessions. We can afford to offer these discounts because we significantly reduce our administrative expense if we are not billing your insurance company and then waiting for 30-90 days or more to get paid (unfortunately that is not unusual). As the patient you have less cost, however your payment to us does not apply to your deductible. If you have a flex spending account or health savings account, your payments to us may be reimbursed.
Often spending two to three sessions focusing on your issue is very productive and can actually save you time and money in the long run. This is especially true if you have a high deductible plan.
Some physical therapy practitioners and clinics will accept a “fee for service” reimbursement or “capitation”. In the last few years insurance companies have cut back on physical therapy insurance reimbursement 30-50%. Physical Therapy clinics that accept a capitated rate may have to reduce time spent directly with a Physical Therapist. Often a co-pay of $30.00-$40.00 is required for a 30 minute treatment. That combined with meeting your deductible, and now you are paying more for PT, than if you paid cash.
If you have a high deductible plan, $2000.00 or greater, you are essentially paying out of pocket. Why not make the choice where you want to go? NOT where your insurance or your health network dictates?
Kenneth Mauck, MPT, MS , Manual Therapy Expert