Have you heard of “cash-based”, “fee for service”, or “out of network” physical therapy services? Have you wondered what the benefits are and why it may be the best fit for you? Hint: there’s a reason so many providers are switching for this model, keep reading to find out why!
So, do you actually have to pay in cash?
Spoiler alert: no, no you do not!
In this post, we’ll dive into the benefits of a cash-based physical therapy, or “fee for service”, model. This form of payment has become popular with private practice owners in the field of physical therapy. I’m one of them! In fact, I left my insurance-based outpatient physical therapy position at a local hospital in part due to the limitations that an insurance-based model has.
What are the limitations of going through an insurance-based clinic?
- Insurance companies may not cover your condition (which you typically do not know until billing has been submitted)
- You are billed more per service when paying through your insurance company than through a fee for service provider (typically)
- Insurance companies can limit and dictate the number of visits you are “approved” to receive, instead of your medical provider determining that with you, the client
- Insurance companies restrict what methods of treatment are “approved” and can be used, thus not covering payment for treatment techniques such as cupping, preventative care, and return to sport
- Insurance companies may choose not to cover your condition, particularly if you are primarily focused on prevention, pelvic health symptoms or return to high levels of activity such as running or sport
Furthermore, many insurance-based clinics have providers treating multiple patients at one time in order to maximize revenue. Do you want to share your providers’ attention with another 1-3 clients at the same time? Nah, I didn’t think so.
Why pay upfront to your provider instead of through your insurance?
Insurance companies serve as the middle-man between the physical therapy provider and you, the patient. A physical therapist performs the agreed-upon service, and bills per 15 minutes of treatment time. These 15 minute units each have a price associated with them, and are billed to your insurance company. A few months later, you receive an invoice outlining what your total price was, and requesting payment for the amount you owe. Typically, these insurance-based bills are in the range of $300-$500 for one 45-60 minute appointment. For a cash-based physical therapy appointment, you can expect to pay less than $200 for these physical therapy services (pricing is provider dependent). Now that’s a big price difference!
So, let’s say you are responsible for 20% of your physical therapy bill. Would you rather pay 20% of $500 or 20% of $200? I’ll let you be the judge!
When you pay your “cash-based physical therapy” provider upfront, you can use an FSA/HSA or credit/debit card. Then, you are able to submit to your insurance company for reimbursement should you choose to do so. Some clients elect not to if they know they will not be reaching their deductible for the year anyways, and simply choose to utilize FSA/HSA funds which many companies provide. If electing to submit to your insurance provider for out of network physical therapy reimbursement, you just need to ask your physical therapist for a Superbill to submit.
How do I file for insurance reimbursement following cash-based PT?
Great question!
First, reach out to your insurance company directly by calling the number on the back of your insurance card. Inquire about out of network coverage for physical therapy, ask if they cover PT for your specific condition, and if they will cover chronic conditions. Even if your insurance company does not cover out of network services, you can apply the cost towards your annual deductible. Medicare patients are an exception to this rule, so if that involves you please scroll to bottom for additional information.
Second, be sure to tell your physical therapist that you need a Superbill to submit to your insurance company for reimbursement. This Superbill is simply your invoice, with additional codes added that notify your insurance company on exactly what services were provided and why.
Third, submit your Superbill directly to your insurance! Options on how to do so are below:
- Load the Superbill directly to your insurance company’s website portal. Typically, this is under the “Submit Claims” or “Submit for Reimbursement” section. Heads up, some insurances use third party softwares for this which their website will launch you to automatically.
- If you find your insurance company’s site difficult to navigate, another option is to submit directly to a third party operator on your own such as Reimbursify. There typically is a small fee associated with going through this third party operator, however they help advocate for you through the process if you are having issues when working directly with your insurance company.
Interested in cash-based PT?
I got you! Currently accepting new physical therapy clients within our Seven Studios location in Grandview Heights, Ohio. Additionally, virtual PT appointments are available for anyone in the state of Ohio.
Looking for a holistic wellness consult focused on lifestyle elements preventing the onset of pain or dysfunction in the first place? Our Holistic Wellness Consults are availability virtually, anywhere you are (no need to in Ohio for this offering).
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Are you enrolled in Medicare? If yes, this section is for you.
Medicare does not reimburse for out of network services if those services are available with an in-network provider. This means, it’s typically in the best interest for patients who utilize Medicare to use an in-network provider. When patients have graduated physical therapy and are no longer considered necessary for “skilled physical therapy”, they may then take advantage of an out of network provider’s wellness offerings (wellness offerings are not covered by Medicare insurance, whether that provider is in or out of network).
