Insurance based vs. Cash-Based PT Practices - "It's Just Math"
- Dr. Q
- Apr 11, 2018
- 3 min read
In my previous blog we discussed health insurance, physical therapy, and the fact that you have more options than you think you had in regards to YOUR healthcare. In this weeks newsletter I wanted to show you all a breakdown of exactly what you are paying for. Because I know many of you still think, "Well, my insurance is going to cover it so I am not going to pay cash for the same service." First of all, insurance doesn't cover what you think. And secondly, let me be very clear about this, it is not the same service as laid out in last weeks newsletter. Do to the greatest misconception - insurance based therapy is cheaper - I wanted to dig into this and clarify why this is NOT the case. In this example we will use Dr. Q's Physical Therapy prices to compare to a typical insurance based practice.
How do the costs of Dr. Q's PT compare to that of a clinic that accepts my insurance?
Most insurance require patients to meet a deductible prior to paying the costs for a Physical Therapy session. Therefore you have to not only pay co-pay, but you will have to pay for the PT bill as well until you meet the deductible. And once you meet the deductible the insured will still be responsible for 20% of the visit in addition to the co-pay.
Conservatively speaking the average individual deductible required before insurance will apply is $1600 (this is a VERYconservative number) and the co-pay average is $40 (typical range is $20-$75). Many of these larger clinics also add a "facility fee" per session, which is NOT covered by insurance and patients do not even realize that this is included on top of what they are paying - for this example I will not add this fee to make things simple.
The average one-on-one patient time with the PT per session is 15-20 minutes
Dr. Q spends an entire hour with each patient
Most insurance based PT clinics will recommend 2-3 visits per week regardless of the diagnosis
Dr. Q typically recommends 1-2 treatments/wk, usually 2 only if the patient/client just had surgery
Insurance based PT clinics average treatment time from initial evaluation to discharge is 6-8 weeks, depending on the diagnosis.
Do to the quality of care that the one-on-one treatment sessions allow Dr. Q to provide, she strives to average 4-6 weeks from initial evaluation to discharge, depending on the diagnosis and severity of the injury
So let’s calculate the difference between utilizing your insurance vs. Dr. Q’s specialized treatments:
Insurance Based clinic
Typical session cost $200
Co-pay $40
Deductible to meet prior to insurance kicking in $1600
Co-insurance after deductible is met 20% - so these visits would be $80 (includes the $40 co-pay)
Dr. Q’s PT
Initial evaluation $150
60 min. treatment session $150
Insurance Based PT ClinicSession Amount Dr. Q’s Physical TherapySession Amount
Initial Eval – $200 Initial Eval – $150
TOTAL = $1600 TOTAL = $1200
What is the difference?
8 Visits Insurance based clinic 8 Visits Dr. Q PT Savings with Cash-Based PT
Total cost $1600 $1200 $400
# of Appointments 18-24 4-12 14-12 appointments
Therapist 1:1 time 2-4 hours 4-12 hours Up to 8 hour difference
*This is just a conservative estimate. Many of the clinics will require at least 7-14 more visits to reach goals yielding an additional $560 - $1120 in out-of pocket expenses. As well as an average of 1 visit more per week and 2-4 additional weeks of treatment. Therefore not only does it result in a greater out-of-pocket expense, but a greater time investment. When it comes down to it, it's really simple - JUST MATH! Once you break things down numerically and more importantly qualitatively Cash-Based Therapy service just make sense! It not only will you save money, but you will save time and have faster results. How can you say no to that?! For more information and tips like me on FB or follow me on Twitter. If you wish to set-up a free 15 minute discovery call I would be more than happy to speak with you 407-796-8229.
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