How Paying Cash for Physical Therapy Will Save You Time and Money!
New Year, Healthier You!
You’ve been struggling with an injury or pain for a while. Unsure what to do about it, you head to your primary care doctor. They do X-rays and prescribe medications. Maybe they even send you to a specialist or a surgeon. During that appointment, the specialist discusses surgery and/or instructs you to modify your physical activities to minimize the pain, hoping it will subside with time.
Essentially, you were just 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 consulting a primary care physician.
You may be asking yourself, “Do I need an MRI before I come to physical therapy?”
This may be surprising to you, but MRIs are often not needed to successfully treat your pain or problem. The main reason for this is that 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 due to poor movement patterns during your daily or fitness activities (which won’t show up on an MRI). Physical therapists are movement experts. We are trained to assess your movement efficiency and 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 traditional method of delivery that does not work. Let me explain.
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 these things that have given physical therapy a bad reputation. It’s viewed as a waste of time consisting 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 waste 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 - which are also beneficial! But, 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.
Are you scratching your head wondering, “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 it’s a full hour of one-on-one care. We listen to your concerns and develop a fully-customized treatment plan just for you!
To make more sense of this, take a look at this infographic: The Tale of Two Care Plans
Let’s compare the same path to recovery for two 40-year-old women recovering from a torn rotator cuff surgery. Fiona chooses to go the private-pay route with Functionize, while Fran sticks with the traditional third-party reimbursement track for treatment.
We will assume one crucial thing: both Fiona and Fran have met their annual deductible and have chosen treatment over surgery. Based on these assumptions, Fran qualifies for reimbursement from her insurance, which looks like 20% out-of-pocket or $50 co-pays per session on average for the Atlanta area.
If we take the “standard” protocol in an insurance-based model for a torn rotator cuff in a healthy individual (25-45), the patient will typically need at least 4 months of rehab requiring passive and active physical therapy (~2x per week) according to the US National Library of Medicine.
Through Functionize’s private-pay model, Fiona will average 10 onsite visits over the course of her 4-month custom-care plan. Opting for traditional, insurance-based physical therapy, Fran will be required to make 32 visits over the course of her 4-month generic treatment plan.
From her first consultation, Fiona feels seen, heard and completely supported by her Functionize Physical Therapist who spends 100% of each appointment working directly with her to build strength & regain mobility. Despite being booked for an hour, Fran only spends about 50% of her appointment time with a physical therapist before being left to fume over sitting in traffic for 20 minutes to work on her own with bands and the arm bike.
Each session introduced dynamic, creative solutions completely catered to her unique needs and progress. Not only did Fiona recover as quickly as possible, but she also felt assured Functionize was in her corner every step of the way. Adding insult to injury, Fran has zero control over or input into her care plan, which leaves her feeling like no more than a number as she repeats the same exercises over and over again.
Fiona invested a total of $1,750 for personal attention and an individualized approach getting her back to peak performance. With co-pay at $50 a pop these 32 visits will culminate to Fran spending $1,600 out of pocket (again, this is assuming she’s met her deductible - if not, cost of care could skyrocket to ~$2,400 out of pocket).
In the end, Fiona saved $600+ compared to conventional insurance-based care and 20+ hours of her time for a high-touch experience and personalized care plan getting her back to the life she loved sooner.
What’s the take home message?
Choosing to pay cash for physical therapy will give you the biggest bang for your buck in both time and financial investment.
Clients at Functionize Health & Physical Therapy love that we focus on their care, rather than chasing insurance companies for reimbursement. We collaborate with other providers (i.e., dietitians, personal trainers, massage therapists, chiropractors, etc.) to create a team approach to your health. Our friendly staff helps answer questions about insurance reimbursement (we provide a superbill with all of the information to get potential reimbursement 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 you sooner!”
If you’re looking for a different approach to your health and functional well-being – that will save you time and money - come see us. You can also give us a call at 404-907-4196 or send us an email at info@functionizehealth.com. We are happy to discuss if going out-of-network is right for you!
Thanks for reading,
-Lauren Sok, Physical Therapist, Owner
Fearless leader and mother of the team, Lauren took the leap to found Functionize in 2015 after nearly 20 years in conventional physical therapy practice with the ultimate goal of creating a new legacy for her family and her colleagues.
Finding energy in helping others and joy in watching them succeed, Lauren embraces childish enthusiasm and overt optimism in the face of entrepreneurship. Despite doubts and challenges, Lauren braved starting a cash-based physical therapy practice at a time when private-pay was a novel concept in the healthcare industry.
To create the dream team, Lauren carefully curated a culture comprised of dynamic, invested and innately curious experts in relentless pursuit of providing best-in-class care and a customized approach for each individual patient.
Lauren’s intention is for her clients to feel they have a coach, partner and friend in Functionize. Her goal is to ensure every person who comes into the Functionize fold leaves with the education, support and empowerment to regain control over health and optimize wellness. Ultimately, she is dedicated to disrupting the current approach to healthcare for one that focuses on humans as a whole as opposed to the sum of symptoms.
Today, Lauren lives in Dunwoody with her husband, Kevin, teenage twin boys, Ethan and Austin, and spunky daughter, Sienna. When she is not running between sporting events, networking socials, supper clubs, carpooling, and school volunteering, Lauren enjoys traveling, running, a lazy day on the beach, OrangeTheory Fitness, and exploring the food and events in Atlanta, GA.
Lauren’s email is lauren@functionizehealth.com. More information can be found at www.functionizehealth.com.