Live embodied physical therapy

Why pay out of pocket for pelvic floor PT?

When I started Live Embodied, a friend asked why I chose to build my practice independently of insurance. 

In response, I found myself emotionally blurting my answer in a stream of consciousness. Which made me realize a couple things… 

1. This is an emotional topic for me- as it should be! I made the decision to become a PT for one reason: to help others. But I made it without understanding any part of the healthcare system I was enrolling in. Choosing to start a private pay clinic was a very thoughtful & purposeful choice that I didn’t take lightly.
2. I wanted to craft a thoughtful post, so that the answer to this question is clear.

Healthcare truly is a behemoth institution and really difficult to understand in entirety. So all of my thoughts and feelings are based on my experience in my specific role in the system… as a specialized physical therapist. An inpatient nurse, family pediatrician, or surgical PA might have different thoughts because they have different experiences. 

And just one more note… I’ve worked on both sides of the coin. For 3 years I worked for an insurance based clinic, where most of my patients used insurance for their care. When I worked there, I provided high quality care that I’m very proud of. But there are important differences between cash-based and insurance based care. 

So first. What is a “cash based” or “self pay” clinic?

It simply means we don’t work with insurance companies & we don’t take insurance. Instead, you pay a flat rate for each visit. You can use any form of credit or debit card and you can also pay via HSA or FSA accounts. 

Why do I not take insurance?

This question has multiple answers…

• More flexibility + creativity with how I can help my patients. For example, I am able to provide unique one-on-one care without concern for quotas. Our sessions last between 60-90 minutes and I even travel to my patient’s homes for visits. I can be even more creative… like meeting a patient somewhere in the community, like a trail that they like to run on or a pool that they swim in, to watch their form and give them tips in real-time. These options are so valuable to me and my ability to provide specialized care to my patients! These options are not possible in an insurance based practice. 

• Aligns with my ethical / moral values as a provider. In physical therapy, there is a financial incentive for clinics to see as many patients possible per day. Basically, clinics make more money if they see 100 patients a day rather than 50. There is no financial incentive to clinics for providing specialized/one-on-one care and there’s no incentive if your patient is getting better. What this means for patients is… you might only see their therapist for 10-15 minutes because they are managing 3-4 other patients at the same time as your visit.
  
  This model does not work for pelvic health PT, and really, isn’t ideal for any patient with any condition. It is against my personal ethics as a provider to sacrifice patient care in order to make a higher quota for better insurance payouts.
  
  Some practices allow pelvic PT’s to treat in 60 minute sessions… Those businesses lose money on us. So our income is capped and it’s hard to make a living (I have personal experience with this).

• Financial benefits to patients. Every insurance is a bit different, but your sessions actually might be cheaper paying out of pocket, rather than using your insurance. For example, if you have a high deductible, using your insurance for PT will be far more expensive than what it would cost if you chose a cash based clinic like mine. Having a high deductible means that you have to spend a certain amount of money out of pocket before your insurance will cover your visits. What’s worse, billing often gets delayed, leaving patients with “surprise” bills months down the road. This particular situation happened to many of my patients in the past, which is a terrible feeling as a provider. Situations where after 6 visits with me, they found out that their bill was up to $400 per visit. Terrible. 

Why might a patient choose a cash practice rather than use insurance?

• They are seeking highly unique, specialized care. The reality is that insurance doesn’t reimburse providers for how good of a PT they are or how much time they spend getting to know a patient’s story. As a PT, it’s so important for me to understand someone’s background, their home life, daily life, and their complex humanity that might contribute to their symptoms. Insurance companies have made it so hard for providers to bill for things like this. Which is insane, because these conversations are HUGE parts of what we do as PTs and are really important to help us best help our patients. So, if a patient is wanting assurance for compassionate, hour (plus)-long visits, one-on-one visits, home visits, or purely preventative care- cash based clinics are able to do this easier than insurance based clinics (since we don’t have to worry about insurance denying anything we do.)

• They want clear pricing with no gray area (no surprise bills). This is a BIGGIE. And very near and dear to my heart.. I’ve been the recipient of MANY surprise bills from medical care. Honestly, who hasn’t??? I charge a flat rate per hour based on whether I’m seeing you in my clinic space or in your home (home visits are a bit more and depend on where you live). You will NEVER get a bill that you didn’t know about or any inflated pricing that wasn’t apparent before you made your first appointment. Payment is simple, transparent, and never delayed. Wouldn’t it be amazing if all healthcare was like this?

• They have a high deductible (Detailed above!)

• They have limited PT benefits from insurance: While some insurance plans might not have a high deductible, they might have a cap on visits for PT. The cap can be high (like 50 visits a year) or it might be low, (like 5-10 visits per year). OR there might be a cap on the amount of money insurance will spend on PT. In these cases, it might be best for patients to start care by using their insurance, and finish with a cash-pay practice. OR save their PT visits for something else and start with pelvic PT at a cash-based clinic rather than switching up providers half way through. 

There is a harsh reality with our healthcare system in the United States. The system prioritizes profits over patient care. In physical therapy practices, insurance companies reward organizations and businesses for quota-based care and getting as many patients through the clinic as possible. This dictates how providers use their time and skills to help their patients; which oftentimes results in less patient-centered, patient-specific care. 

I want to make a last note on the topic… I made the choice to build a cash-pay clinic because it aligns with the way I want to practice and treat patients. When a patient calls, wanting pelvic PT but needs to use their insurance to access care, I happily refer them to my colleagues who take insurance. Insurance is wonderful to use in many situations, and helps people get the care they need- I never want to stop someone from getting the care they need. There are a lot of pelvic floor PTs who work in the Salt Lake Valley who I look up to, are incredibly good at what they do, and also take insurance (some of them are dear friends of mine!)

My goal is not to say everyone should 10000% only ever use cash practices like mine to solve their pelvic floor issues. Again, lots of insurance based providers are really wonderful and provide their patients incredible care and education. I also don’t think there’s a point in being competitive with other providers because there are way more people who need pelvic floor help than there are therapists to help them.

But when it came to crafting and building my practice, to me, there are more benefits to my patients to ditch insurance and get creative!

Cheers, to healthy and happy pelvic floors… however we all get there!

-Sam