c478a14d65e9cf90603f4532bb839121.png

WHICH INSURANCE COMPANIES DO YOU PARTICIPATE WITH?

Easy question to answer – NONE.

My practice is completely cash-based.  Here's why:

·       Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at many, if not most, in-network clinics have to see at least 2 patients per hour (sometimes even 4-6)

·       To help “manage” these many patients, PTs often use assistants and unlicensed aides to provide much of the actual patient care.

·       PTs in such clinics spend, on average, only 10-15 minutes with the patient; the remainder of the session may consist of modality treatments, such as ultrasound or electrical stimulation, provided by a PT Assistant (PTA).   Such interventions have been shown in most clinical studies to have very little benefit, but remain a staple of the profession because … well, just because that’s how it’s always been done.

·       In many cases, the majority of a patient’s time at the clinic is spent doing exercises (under the “guidance” of an unlicensed aide) they could do on their own time.  (But because you're doing them in the clinic, there's a charge.)

·       I do not believe that modalities are nearly as effective as hands-on manual therapy, and I also do not support having patients pay to perform exercises in the clinic that they can easily perform at home or at a gym.

·       Most outpatient clinics expect patients to attend 2-3 appointments per week, again in large part because “that’s how it’s always been done,”  not because studies confirm that this is the optimal frequency.

Listen – I get it.  And I don't mean to denigrate my colleagues.

Having worked for 35 years under the insurance model, I fully understand the economic pressures of maintaining a viable practice and the necessities of limiting the amount of time a physical therapist can spend with each patient.  The reality is that most insurance companies (especially Workers Compensation and No-Fault) have a cap on the amount they will pay each session and this amount mandates a maximum of 30 minutes therapist/patient contact to be financially feasible.

But just because “that’s the way it is,” it doesn’t mean that’s the way it should be, and it’s no longer the way I wish to practice!

My experience tells me – and I absolutely believe – that patients will derive far more benefit from a single one-hour session per week that consists of a combination of targeted exercise instruction (your homework) and manual therapy (soft-tissue and joint mobilization/manipulation, massage, neuromuscular assisted-stretching techniques) than they will get from 2-3 sessions per week in a traditional delivery-system as described above.

Despite my making this argument, I imagine your next question is:

EVEN IF WHAT YOU SAY IS TRUE, WHY WOULD I CHOOSE TO PAY CASH WHEN I CAN USE MY INSURANCE COVERAGE I’VE ALREADY PAID FOR?

And a very legitimate question it is!  Here’s the answer:

The unfortunate reality is that for the past decade or so, private insurance companies (Excellus, MVP, Aetna, United Health Care, etc.) have shifted more and more of the costs for physical therapy to the patient.  They have done this primarily by raising co-pay amounts to what almost everyone (except the insurers) agrees are unreasonably high rates.  They have done this in many cases by classifying physical therapists as “specialists,” thereby placing us in the same category as medical providers such as orthopedic surgeons, neurologist, urologists, dermatologists, etc., for whom you pay a higher co-pay rate than your general primary care provider (usually family physician).

While the co-payment for your PCP may be $10-15 per visit, specialist rates now average between $40-50 per visit.  While this may be reasonable to some degree in the case of a doctor you see once every 6-8 weeks, it can be an incredible financial burden for a patient to have to pay this 2-3 times/week for PT ($80-120!).

Moreover, when you consider the fact that this $40 amount for a physician specialist represents perhaps 25% of the total amount allowed the doctor by the insurance company, while the same co-pay represents as much as 80% of the amount allowed for one PT visit, this cost-shifting maneuver appears to be even more outrageous.

For the past 10 years, I have been one of the leaders of the New York Physical Therapy Association’s battle in Albany to change this unfair practice by insurance companies and, unfortunately, I can say with some degree of certainty that our legislature is not likely to pass any laws to alleviate this situation; such is the power of the insurance industry in our state capital.

VERY INTERESTING, FOR SURE – BUT HOW DOES THAT AFFECT MY DECISION TO PAY CASH RATHER THAN USE INSURANCE?

OK – time to do some math:

2-3 visits/week @$40/session = $80-120

1 visit/week @$100/session    = $100

So -  you pay maybe more, maybe less. 

Now let’s look at your cost per PT/minute (amount of time the physical therapist actually spends with you):

30-60 minutes/week of PT time (15-30 minutes, 2x/week) = $2.67-$1.33 per minute PT time.

60 minutes/week PT time = $1.66 per minute PT time

So – even if you have a PT who will spend 30 minutes/session with you, the amount you save is minimal in terms of value.  And when you add in your travel time to go to therapy 1-2 times more per week, as well as disruption of your week….

Ultimately, you are the one to make the decision whether this makes sense for you to forego your insurance coverage.  I could toot my own horn and add quality of service to the mix, but at the end of the day, that would be your judgment and, unless you’ve seen me in the past, you’d have to take a leap of faith to see for yourself if there’s a difference in the outcome of your problem.