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


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.

r/AdviceAnimals - As long as insurance companies are involved. Aetna is proof of that this morning


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 [caption id=”” align=”alignnone”

Despite the looming costs, most physical therapists complete the requirements and more to provide a higher level of care to our patients.

Unfortunately, doing this does not always equate to an increase in pay. Quality does not equal quantity. Other than the rare opportunity to become a clinic manager/director, which will take providers away from patient care, many physical therapists have more than one job to earn more additional income.

From that perspective, you can see how those working in healthcare might become “burnt out.” This becomes more and more real as physical therapists learn that they will need 20 years of experience to earn a 30% increase in income.

Opportunities for Advancement Cost vs. Effect on Pay
Continuing Education (post-graduate)

reasonable to expensive cost

without increase in pay


20-30 hour pay during or flat fee $4,000-$12,000

with possible increase in baseline pay


not costly TO very costly

with possible increase in baseline pay


not costly TO very costly, no-moderate upkeep costs

with possible increase in pay


expensive, moderate upkeep costs

with possible increase in pay

Clinic manager/director

more time consuming, overwhelming responsibility with OR without patient care

with increase in pay

Benefits of finding cash providers

This is why successful cash practices have better providers. This is a general statement, with the realization that it is very dependent on the person and culture of the practice.

In the cash-based setting, we have a lot less to worry about such as:

  • extra documentation
  • productivity requirements
  • slow salary growth
  • insurance approvals/reimbursement
  • committing years of work
  • seeing several patients at one time
  • seeing patients >1-2x/week
  • working with patients who don’t appreciate our services (these people are often told they must complete PT in order to get their pain medication, MRI, or seeing a specialist)

In a traditional setting, the type of care provided is often dictated by what the insurance provider will pay for.

Unfortunately does not often include preventative care, disease management, time spent on health and wellness, movement assessments, desk set-up, healthy behaviors, etc.

Now that you’re ready to start looking for your cash-based healthcare team (!) here are some other terms used to describe cash-practice:

  • non-traditional
  • non-insurance based
  • cash-based
  • concierge services
  • out-of-network

Our out-of-network providers spend time with patients one-on-one and take the time to educate you on your condition. We don’t feel rushed by documentation or productivity requirements and can build a better relationship with you. We will work with you on your health and wellness goals, whether that be sleep hygiene, basic nutrition, dealing with stress, getting back into a good exercise routine, etc.

About the author:

Dr. Sarah Cash Crawford, PT, DPT, COMT, CMTPT, is a Physical Therapist and Certified Pilates Instructor. She has been practicing physical therapy for over 10 years. With a background in neurologic rehabilitation, manual therapy, and a specialty in treating chronic pain, Dr. Crawford has advanced training in orthopedic manual physical therapy and holds a certification in Geoffrey Maitland’s approach. She was also the first student certified by Myopain Seminars in Dry Needling, holding her Certified Myofascial Trigger Point Therapist credentials since 2014. Dr. Crawford studied Pilates early in her practice to further expand her treatment options to help patients overcome physical limitations. Dr. Crawford is the founder of the Anchor Wellness Center & Anchor Wellness, Inc., an integrated health and wellness collaborative.