Why doesn’t Perspective Physical Therapy bill insurance? And how does it save me money?!
Insurance companies have a strong influence on patient care at “in-network” clinics. Although they do not have any interaction with patients in the clinical setting, many times they dictate reimbursement rates and limit the number of visits a patient is allowed. Unfortunately this can many times lead to a lack of quality in patient care. We refuse for this to take place at Perspective Physical Therapy.
We are an “out-of-network” practice because it allows us to give the highest-level care we insist our patients deserve. Due to worsening reimbursement rates, and added pressure from insurance companies, therapists at in-network clinics MUST see at least 2 patients per hour (typically it’s 3-4 patients per hour!) and they often use aides and assistants to provide much of the actual patient care.
Imagine going to a physical therapy clinic where your physical therapist juggles between 4 patients. If the time is split evenly between all 4 patients, you can only see the physical therapist for 15 minutes out of the entire hour! Then, you’re off on your own doing exercises you could be doing at home with little guidance. Or worse, you’re hooked up to modalities such as ice packs and ultrasound without any supervision. Add to this a requirement to go 2-3 times per week, and we have an equation for a very unhappy patient who not only isn’t able to get back to doing the activities they want to, but also spends a fortune going through this process. This is sadly a common story we hear from our patients who have tried physical therapy at in-network clinics with limited results.
We believe that our hands-on treatment approach is far more effective than any modality, and we find it immoral to have patients pay to perform exercises in the clinic that they could easily be doing on their own at home or in a gym.
Every single one of our patients receives hands-on, 1-on-1 care, from a Doctor of Physical Therapy during each treatment session. Usually we see patients for a full hour unless they request to only be seen for 30 minutes. With this focused 1-on-1 treatment approach, we are able to see many of our patients as little as one time per week while achieving positive results.
When you consider the savings you make in time and money by making fewer appointments, and the value of resolving your pain in less treatment sessions, the out-of-pocket expense you pay at Perspective Physical Therapy is a significant bargain.
In addition, the out-of-pocket expense for our treatment sessions are sometimes less than what you would pay at an in-network clinic that accepts and bills your insurance. How is this possible?
As deductibles and physical therapy copays continue to skyrocket, many of our patients who have high PT copays or have not met their deductible pay less out-of-pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before choosing where to get physical therapy, please make sure you know how much you’ll be paying at an in-network clinic that “takes your insurance” compared to an out-of-network clinic like ours… The quality of your care depends on it!
Some insurance plans provide ZERO coverage for physical therapy services which means you will be paying out-of-pocket for all of your PT sessions. Other insurance plans require copays of over $50 per visit, and if you haven’t met your deductible you will be paying the full remainder of the bill until your deductible is met (and these bills are often over $200 per visit!). If you are going to physical therapy 2-3 times per week for 6-8 weeks, this bill can reach $2,400 to $4,800+ (which YOU would be expected to pay if your deductible hasn’t been met).
Now they would never tell you this upfront. Often patients go through a plan of care and it isn’t until after 6-8 weeks that they start receiving those massive bills at $200+ per visit. It gets worse… just because you’re paying $200+ per visit at an in-network clinic, it does NOT mean that your insurance is applying that full amount towards your deductible! Often they apply an “agreed upon amount” that they consider reasonable for your PT sessions, and usually this is much less than the amount charged by the PT clinic.
Insurance companies do everything they can to pay out as little as possible and maximize their profits, and keeping consumers ignorant is part of the game.
So as you decide on your options for physical therapy, make sure you find the answers to the following…
Questions for your insurance company:
Until I meet my deductible, what can I expect to pay for each Physical Therapy session at an in-network PT clinic? They might only be able to give a percentage, but many times PT clinics are billing over $200 per session. Make sure you find this answer before asking the first question in the next section (Questions for PT clinics).
How much of my deductible is left that I have to meet?
If I have met my deductible, how much will my copay be?
What can I expect in reimbursement if I get physical therapy from an out-of-network provider and send in self-claims? (FYI: insurance companies' customer service agents are instructed to discourage people from going to clinics that are not in-network! So be very clear that you want to know what your out-of-network benefits are.)
In most cases, you will be paying the ENTIRE bill until your deductible has been met.
Questions for PT clinics:
What is the average dollar amount sent to an insurance company for the physical therapy bill? (Make sure to clarify that you want to know what the PT clinic charges the insurance company, NOT what the insurance company has agreed to pay the clinic.) If you have not met your deductible, you would be expected to pay the full amount billed to the insurance company.
On average, how many patients do the physical therapists treat per hour? Are only physical therapists providing treatment, or are assistants and aides/techs used?
How much 1-on-1 time will I get with my physical therapist each session? How much of that time will be hands-on treatment?
On average, how many times per week do patients come in for treatment?
Consider the quality of care you’ll be receiving. Ask yourself, “How much do I value receiving higher-quality, 1-on-1 care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled tech/aide?”
Also think about how often you’ll be missing work, time with family, and time with friends to attend your PT sessions. Again, you can always ask any PT clinic how many times patients come in for treatment per week.
After finding the answers to the questions above, and figuring out the financial calculations, you might be surprised with what you find.
*One last thing to consider is whether or not you have 2 separate in-network or out-of-network deductibles. If you have 2 different deductibles, then sending in claims from an out-of-network provider like ours will NOT apply towards your in-network deductible.*
Once you find the above information, you can get a real sense of the true cost of your physical therapy care. But more important than cost, figure out what level of care you’ll be getting. Make sure that whichever place you ultimately decide to go to for physical therapy will get you back to doing the things that you love.
What is a self-claim? How does it help me with reimbursement?
Upon request, we will provide you a Superbill that has the necessary information for you to seek reimbursement if you choose to do so. A “self-claim” is the act of you sending the Superbill to your insurance company. Your insurance plan determines the amount of reimbursement or amount applied to your deductible. If you call your insurance company, make sure to ask about reimbursement for “Out-of-Network Physical Therapy” to see how much they will cover if you send in self-claims.
If you have Medicare:
Since we do NOT have a business relationship with Medicare, we can only work with Medicare patients who do NOT want Medicare involved with PT services. Patients must - with their own free will - specifically request that they do not want Medicare involved with payment.
So if you are a Medicare beneficiary, and you really want us to work with you, you must be very clear that you don’t want Medicare involved. You must clearly state upon arrival that you do NOT want Medicare to be billed or be part of your physical therapy care.
If you DO want to use your Medicare benefits for physical therapy, we unfortunately will NOT be able to provide you treatment at our clinic. However, we will gladly refer you to a good Medicare provider.