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Why pay cash for medical services?

Insight into the physical therapy profession that can be applied to other professionals

To put it simply, the practice of medicine is often handcuffed by insurance companies. Providers that choose to collaborate with insurance companies do so in order to have a network of patients. Similarly, patients pay the insurance companies for access to medical providers at discounted rates. At the end of the day, patients pay a high premium for access and providers lose a large part of their rates for their stake. The winner is often the insurance company who squeezes out providers and passes costs to clients.

So now that you understand who the winner is in this game, I’ll let you in on a few more secrets and discuss why we choose to be out of network.

To earn your wage in a traditional setting, you have to do more than show up

Productivity

Providers are “required” to meet a certain level of productivity. Productivity is the amount of ‘productive hours’ or time spent with patients and providing care, compared to the total amount of hours worked.

This does not include any non-billable time. For example, documentation is not considered productive. That said, most therapists find themselves completing their notes during non-paid hours (lunch and evenings). Some practices provide incentivize productivity by offering a bonus.

Almost completely out of a PT’s control, cancellations and no-shows by patients is a negative mark on a therapist’s schedule, often directly affecting their pay. Taking into consideration all of the above and in order to meet productivity and therapeutic goals, patients are often seen several times a week. To be fair though, for many conditions this is very appropriate but differs from a fee-for-service practice that has more flexibility with less pressure.

An example of hospital-based billing

When an outpatient practice is attached or in near distance to an emergency department, they are able to charge in-patient prices.

Typically, a stand-alone outpatient facilitate will charge between $250-350 per visit. On the other hand, an average hospital-based outpatient facility can bill upwards of $500-$600 per visit.

[Now depending on the services you receive, the amount of time spent, and the type of setting you go to for physical therapy services the cost billed to insurance will vary.]

Most individual’s deductibles are rising as are co-payments. When we worked in traditional settings, our patients had co-pays of up to $150 for each visit! Co-payments are usually around 20% of the billed amount.

Patient cost = $25-75 co-pay + 20% co-insurance (20% of $600 = $120) after meeting deductible (anywhere from $500-7500).

Financial Burden: Large Cause of Burnout

Physical therapists love working with their patients, in their setting, and with their co-workers. However, there is more and more pressure to pick up extra work and responsibility to earn more income. This is especially true if we want to support our families, build wealth, and pay down our heavy-hanging debt.

Cost of being a physical therapist:

• about 25 hours ($2,500-$4,000) of continuing education yearly
• $100-$300 state and national fees for license and certification/s bi-yearly
• doctorate level education with $100,000-$200,000 student loan debt [/et_pb_column][/et_pb_row][/et_pb_section]