I’ve been meaning to write an article about this for awhile now, and since the New Year and the many changes in the insurance industry it’s prompted some action on my part.
The current trend in the health insurance industry is to increase the patient’s responsibility for their health care. This shows up in rising co-pays that are as much as $60 per visit or deductibles that can be as high as $10,000. This pretty much means you pay the first $10,000 of your medical expenses before the insurance company starts kicking in anything. On top of that you max have an ‘out-of-pocket’ max to reach so that you may still have a co-pay or a co-insurance until you reach that magic number.
I’ve had this type of insurance myself so I know full well how it works. To be able to afford the monthly premiums anymore, some folks are forced to go this route and then pray that nothing bad happens to them or their family.
I’ve always offered what I think is a rather fair private pay rate since many people didn’t have insurance prior to the Affordable (laugh) Care Act. Everyone is required to have insurance from this point forward or pay a fine. Many younger folks are choosing to pay the fine for now since it is much cheaper than paying for insurance they probably will not use. In this case private pay for physical therapy is a no-brainer.
Now what about for those of you that do have insurance? This is where is can be a little tricky.
The private pay rate here at Elite Physical Therapy is $75 per visit. This was the lower end of what insurance companies would typically pay for a physical therapy session, although with cost cutting more companies are hovering around this point. There are still companies that do pay significantly more than that depending on what is billed.
The typical session at Elite is 45 minutes (60 minutes day 1 with the evaluation), and is one on one with the physical therapist. You have 45 minutes of my undivided attention plus access to me by phone or email with questions. The typical frequency of visits is 2x per week, and in some cases 1x if cost, schedule, or distance are issues.
That being said, for a person who is private paying for physical therapy, that would come to $150 weekly.
Most clinics are going to see you at least 2-3x per week so if you have a $50 co-pay you’re already up to $100-150. Not only that but most other clinics in this area will allow you 15 minutes with your therapist and the rest of the session is spent exercising on your own or with a tech. You may save a little, but the quality of care may not be the same.
Here are a few other scenarios I have run into where someone chooses private pay over insurance:
- They do not anticipate meeting their deductible and choose to pay the $75 private pay rate rather than what they would be charged if it were billed through the insurance. Going through insurance can cost as much as $225 for the first visit and $90-120 for subsequent visits.
- Some people would just rather keep their health information between them and their doctors so they request to private pay versus going through their insurance. I’ve heard a number of valid reasons for this but the big one being concerns over the deductibles going up (much like claims against auto or home insurance).
Here are a couple other points to consider when choosing between private pay and insurance, or even which PT clinic is right for you:
- My thought process with many injuries/conditions is that you should see substantial improvement within 4-6 sessions. I tell my patients this right up front. You may not be 100% that quickly but you should be well on your way. I don’t want to waste your time and money so if things are not improving in that time frame its time to go back to your physician. I hate to say this but I’ve had patients come to me with 20-30+ visits to PT under their belt already and no results.
- Many clinics in this area do not give discounts for private pay physical therapy! PT services, just like physician or hospital services, are billed out at a much higher rate than what would actually be paid out. It’s a game we all have to play with the insurance companies unfortunately, but to bill a patient that same rate to me is ridiculous. At a minimum you’re probably talking $150 for a 30-45 minute session.
- This goes along with the point above – I’ve done some checking and as far as I know I have the cheapest private pay rate around. I’ve even had a couple referrals from other PT’s because their ‘friend’ didn’t have insurance and I had the best rates.
The point of this article is to let you know that you have options! Great care for a fair price is what it’s all about here. If you have any questions at all feel free to contact me at 231 421-5805 or shoot me an email: firstname.lastname@example.org