Why Cash-Based PT?
Hello everyone! This month we’re chatting about the benefits of cash-based, or “out-of-network” physical therapy. Check out related content all month on our Instagram feed @pelviccare and our Facebook page, Pelvic Care Physical Therapy. Thanks for joining us!
As I shared in last month’s newsletter about trauma-informed care, the main reason I run Pelvic Care Physical Therapy as a cash-based practice is TIME. When your provider doesn’t have to spend time (and money) jumping through the hoops set up by insurance companies–they get to invest that time in you, in taking excellent care of your body and your whole self. So you get better faster, and have a more pleasant time getting there. That’s it, in a nutshell.
Now, here’s some details. What are the hoops that insurance companies set up? First off, some insurance companies require a specific sequence of referrals to be eligible for coverage of physical therapy–you may need to visit your primary care doctor, and then a specialist (sports medicine physician, or urogynecologist), prior to being referred to physical therapy. If you are seeing a cash-based PT, you can see a PT first and you and your PT can collaboratively determine whether physical therapy is a good fit for your condition.
Another hoop: Most insurance companies require a lot of very specific documentation which costs time and requires infrastructure/systems to generate. They require regular progress notes and re-certifications to provide ongoing data indicating that progress toward goals is being made, and they won’t pay if they aren’t convinced. Traditional physical therapy companies spend time and money learning how to optimize insurance reimbursement via documentation; then the physical therapist or PTA you see spends time carefully crafting that documentation, each visit, to make sure their company gets paid. As a PT patient, you pay for this time, but it is not spent on you–it’s spent on insurance. Cash based PTs get to spend that same time and money learning and improving skills relevant to direct client care, and they get to document in a way that optimizes their clinical reasoning and client-specific data tracking. So we become better clinicians, rather than better technical writers. A worthy trade off, in my opinion, for a doctor of physical therapy whose job is to heal bodies (not writing fancy sentences).
Yet another hoop: Insurance companies have specific rules about what will be covered, and what won’t, and how you should sequence certain interventions.. They won’t pay if they think enough progress has already been made (even if you, the client, want to go further). They pay a little bit more for “neuromuscular reeducation” than “therapeutic exercise” (but why!?!) If you do all manual therapy, they may not pay. You can only do electrical stimulation, if you’ve documented failure with therapeutic exercise for a certain number of visits. They come up with their own rules for these determinations, and they are often about the clinician knowing how to use the right catch phrases and check the right boxes and follow the made up rules. Unfortunately, the rules aren’t focused on providing evidence-based interventions (although some claim/try to be), nor are they client-centered and focused on the client meeting their particular goals (although some claim/try to be). Primarily, they are focused on maximizing the insurance company’s profit.
One last hoop to consider: Insurance companies won’t cover your physical therapy if they think your concerns are not a “medical necessity” (even if you, the client, consider those goals important). Medicare, for example, basically does not cover most pelvic floor related concerns other than incontinence. They will pay for people to receive physical therapy for urinary incontinence and fecal incontinence, but not for pelvic pain, not for pain with sex, not for erectile dysfunction, not for urgency, not for prolapse, not for constipation, etc. There is no logic behind this that I am aware of; it’s a line in the sand. Regarding insurance in general: Preventative/proactive care, like working on rebuilding your core strength in between having your first and second child, to prepare for a healthy second pregnancy and childbirth, is not typically covered. Athletic performance issues, not covered. Getting from 80% better to 110% better after an injury to prevent recurrence: not covered. If you’re working with a cash-based PT, you and your PT get to decide what’s important to you. You focus on your goals, rather than lines drawn in the sand by a middleman.
OK, so enough negativity already. Here are some wonderful things I get to do as a cash-based provider, that I couldn’t do as well when I was taking insurance:
If a patient comes in crying, I can sit with them while they’re crying, instead of worrying about billable minutes. ALWAYS, whatever they’re crying about is 110% relevant to their holistic care and wellness, and talking about it is a really good use of our time.
If a client brings up an issue that wasn’t on their initial plan of care/list of concerns, we get to work on it that day–instead of requiring them to get a separate referral for that concern prior to addressing it.
I get to do 1.5 hour evaluations, carefully considering pelvic, orthopedic, and psychosocial concerns in the initial appointment, so that my clinical reasoning about a client is both laser focused and holistic from the beginning. (Please note: If you want a shorter, hour-long eval, those are available too!)
I get to do 55 minute follow ups instead of having only 25 minutes with clients like I did when taking insurance–allowing me to be thorough, thoughtful, and have a balance between manual therapy and movement and lifestyle/behavioral change that I didn’t have time for before.
Mommies can bring their babies in if they need and take breastfeeding breaks–and I don’t have to worry about billable minutes.
I have the time to learn what I need to help my clients get better faster. So when a client hits a plateau with progress and I know it’s because they need x/y/z intervention I don’t know how to perform yet–eg, balloon training or how to perform an ilioinguinal nerve glide–I have time to research and learn that thing.
I get to help people access the care they need, even if it’s not with me. If their PT with me isn’t efficiently helping them reach their goals, I get to refer them to another provider or another specialist who I think will help them get there faster–rather than optimizing my own financial bottom line over their wellness. If a client calls and has met their deductible and needs to use their insurance, I get to refer them to another excellent pelvic specialist PT who will take their insurance.
I have time to network with practitioners inside and outside the “medical” world–physicians but also doulas, midwives, massage therapists, physical trainers, nutritionists and dieticians, sex therapists and other LPCs and LCSWs, and other providers who can be important “pieces of the puzzle” for my clients. This way, I’m prepared to help clients create their medical/care team.
If you have any questions about how cash-based pt works, I’m more than happy to answer them! Or you can check out our content on Instagram and Facebook this month.
Thanks again for joining us!