If you’ve ever had an injury or some sort of pain, you probably followed a very traditional course of action to address it. You visited your primary care doctor who sent you to get an X-ray, prescribed medications, or both. They may have given you a referral to see a specialist or even a surgeon. During that appointment, the doctor may have suggested surgery or instructed you to modify your physical activities to minimize the pain, hoping the pain would subside with time. Essentially, you were put into the assembly line that is our current healthcare system.
What you may not have known is that you could bypass all this trouble – and get better faster – by going directly to see a physical therapist?
That’s right! In the state of Georgia, physical therapists can directly see clients for 21 days without a prescription for physical therapy. Because physical therapists are trained to diagnose musculoskeletal problems and provide an individualized treatment plan (without medications), people can see immediate results before even seeing a doctor.
You may be asking yourself, “Do I need an MRI before I come to physical therapy?”
This may sound surprising to you, but MRIs are often not needed to successfully treat your pain or problem. The main reason for this is because there is a high percentage of “abnormal” findings (i.e., disc bulges/herniations, partial tears, arthritis, etc.) in people who aren’t experiencing any pain. In other words, MRI results can be very misleading. Additionally, the cause of your pain may be caused by poor movement patterns during your daily or fitness activities (which won’t show up on an MRI). Physical therapist are movement experts. We are trained to assess your movement efficiency and can resolve most musculoskeletal problems without any special tests or doctor visits.
Now you’re saying, “How does physical therapy even work?”
Physical therapy DOES work. It’s the method of delivery that does not work.
Over time, insurance companies have placed limitations on reimbursement for physical therapy. In clinics that bill insurance, therapists must see multiple patients at one time to offset insurance reimbursement rates. On average, insurance companies tend to reimburse about 40% of what a therapist bills out. Many outpatient clinics are forced to utilize support staff to oversee patient care. Often a patient may only spend 10-15 minutes with the physical therapist and be sent off to complete their exercises independently. In addition, insurance companies tend to dictate the number of sessions a patient is allowed regardless of the nature and depth of their injury or condition, causing them to stop therapy short and putting them at increased risk of re-injury.
It’s all of this that has given physical therapy a bad reputation as a waste of time that consists of doing a bunch of exercises. In essence, it’s not the physical therapist’s fault, but a flaw in the delivery system of healthcare that’s concerned more about their bottom line than your outcome.
If you want to speed up your recovery without medications or unnecessary procedures like injections or surgery, then don’t go the traditional physical therapy route. You will feel that you are wasting your time by doing a bunch of unsupervised exercises without a game plan. So, what does this mean…you need to go outside of your insurance and pay out of pocket.
This is called going “out-of-network” and means you must pay for your physical therapy.
As our health insurance costs rise, more and more people are choosing to take ownership of their health by paying for services themselves. The misconception is that physical therapy is really expensive and instead choose to spend their money on massage therapy, acupuncture, chiropractic care, and personal trainers as a means to stay healthy. Most people don’t think of paying for physical therapy because they don’t realize that it can save them money. Yes, seeing a physical therapist out-of-network can save you money and more importantly – time.
Now you are scratching your head, “Why would going out-of-network save me money?”
Simply put, physical therapists that are not in-network with insurance companies are able to spend more time with you (in our case a full hour of one-on-one care). We can listen to your concerns and develop a fully customized treatment plan just you for!
Here’s an example that may make more sense. Most clients at Functionize Health & Physical Therapy attend physical therapy for 6-10 visits. Those visits may be spread over 2-6 months with a combination of in-person visits, home exercises, email communication and even phone conversations. In an insurance-based model, physical therapists are incentivized to get you in for therapy as often as possible to meet monthly financial goals. You may attend 10 sessions in just 4-6 weeks, but it can take longer that 6 weeks to treat a problem that has lasted for several months. In 6 weeks you may be feeling better, but that may not be enough time to fully treat the problem. Although the pain is better and you saved money in the short-term, it may end up costing you a lot more in the long run, especially when the pain comes back. In the end, you feel that physical therapy didn’t work and revert back to the expensive lines of treatment that you never really wanted – like surgery or injections.
What’s the take home message? Choosing to pay cash for physical therapy will give you the biggest bang for you buck (in both time and financial investment).
Clients at Functionize Health & Physical Therapy love that we can focus on your care, rather than chasing insurance companies for reimbursement. We collaborate with other providers (i.e., personal trainers, massage therapists, chiropractors) to create a team approach to your health. Our friendly team, helps answer questions about insurance reimbursement (we provide a "Super Bill" with all of the information to get reimbursed from your insurance) or use of your Flexible Spending Account or Health Savings Account. In the end, most clients would agree, “I wish I would have come to see you earlier!”
Thanks for reading,
-Lauren Sok, Physical Therapist
Lauren Sok, Founder of Functionize Health & Physical Therapy, brings 18 years of physical therapy practice and expertise in treating orthopedic and sports medicine related injuries. She incorporates a functional medicine approach in treating the whole person to find the root cause of a problem, rather than treating one body part at a time. Lauren holds a Master of Physical Therapy and Bachelor of Science in Health Science from the University of the Sciences in Philadelphia. She is a Certified Stott Pilates Instructor, a Clinical Instructor at the Doctorate of Physical Therapy Program, Emory University, and is trained in Redcord Neurac and Trigger Point Dry Needling. Lauren’s email is lauren@functionizehealth.com. More information can be found at www.functionizehealth.com.