Why I Ditched Insurance for a Cash Based Model

June 22, 2016

I love being a physical therapist and having the opportunity to help dancers reach their full potential, it is definitely what I was put here to do. That is why I started On Pointe Wellness and Rehab, so that I could do more of what I love every day. It is also why I decided to take the unconventional route by ditching the traditional insurance model and move to a cash based system. Before you decide this is a terrible idea that will never work, hear me out.


Let me start off by explaining to you what cash based Physical Therapy is. No, it doesn't mean that I only accept actual cash but it does mean that I do not accept insurance of any kind. It essentially means you are seeing an out-of-network provider with your insurance company. You can later submit the receipt to your insurance company for reimbursement on your own, depending on your out-of-network benefits. This eliminates the middle man by having you directly deal with the insurance company yourself and allows me more freedom to focus on patient centered care. More and more providers are making the change to cash based services, and with good reason. Although it sounds a little unconventional at first, the reasons behind it are sound and make much more sense once your educate yourself on it.


A little history on me....

I remember the exact moment when I knew I wanted to work as a cash based Physical Therapist. I was in PT school listening to a lecture about insurance reimbursement and blah blah blah.... The professor mentioned how there is a certain sector of practice in which therapists were working on a cash based, or out of network, model. He mentioned that it wasn't common, but he had a friend who was very successful at it. Even without the insurance they always had a steady stream of patients because they were able to provide something that others couldn't-- a higher quality of care. Even as a PT student who knew very little about the inner workings of insurance I was already sold.


This whole idea is, in fact, why I decided to start my own business. I have never been someone who likes being told what to do and I felt that as long as I was working for someone else, I would never be satisfied. I also knew that as long as I was working with insurance companies I would always have to deal with someone else dictating how I was to treat my patients. I don't feel it is right for an insurance company (run by someone who is not a qualified health care provider) to tell me how a patient should or should not be treated. After all, I did graduate with a Doctorate degree... I have to loans to prove it! We entrust our health care providers to be the ones making educated clinical decisions about our health care, and as much as your health care providers try to make decisions without the influence of what insurance tells them, it is becoming nearly impossible to do. Think your insurance company actually cares about keeping you healthy? Think again. Their sole purpose is to make profit, even if denying justified care is the way to do it.


As a therapist who works with dancers, one of the problems that I was running into was the patient being denied care because they didn’t have problems in their daily life, even though they were significantly impacted in their dancing. Of course, you and I both know that a dancer who cannot properly activate their turnout muscles during a grande plie gives me plenty of well-justified reasons to provide Physical Therapy services, but the insurance companies feel otherwise. Who cares if you can't go en pointe without pain, or lift your leg above 90 degrees without snapping hip pain? Don't do those things and you won't need PT-- case closed and claim denied.


This is not just dancers that run into this problem. I see people with all types of injuries who must be discharged before they are pain free or have fully met their goals. It makes no sense to only get someone 3/4 of the way better then set them free, because they will come back hurt again. Insurance companies-1, Patient- 0. 


Luckily, insurance companies do allow you to fight for your patients and get their care covered, but it involves a ton of paper work and red tape to get around. In certain cases, I was having to send in documentation every single visit I saw a patient, because each time the insurance company would approve only one visit. Yes, you saw that correct-- one visit. Let me just wave my magical wand over you and get your stronger in 1 visit...


To me, as a provider AND a patient, I would much rather see those valuable hours spent helping people instead of doing an endless stream of paperwork which may only be denied in the end. 


The other problem with insurance companies is that your provider doesn't get paid unless the insurance company reimburses them. With each passing year, reimbursements rates are getting lower and lower. So how do we make enough money to sustain a business? See more patients of course! One thing you get really good at as a Physical Therapist is time management. So what's the problem with that? I don't want to manage my time between more than one patient. Again, as a provider AND a patient, I am a firm believer that one-on-one care is the way to go. Yes, you can and will get better if you don't always have one-on-one care, but it just isn't the type of therapy I myself believe in. I went to a great college and had great mentors along the way, all who taught me the importance of spending quality time with your patients. So I blame you all for making me this way ;-)


I love spending time with my patients, getting to know them on a personal level and understanding what makes them tick. By doing this, I am treating the person as a whole, not just another number walking through the door. I can promise you, when you choose a health care provider who takes the time to do this it will make all the difference in your healing process. 


Specifically, working with dancers is quite specialized and it takes the right eye to be able to analyze and correct movement to reduce injury and pain effectively. To me, this equates directly with patient centered care in a one-on-one setting. It allows me time to spend educating my patients about movement and anatomy in a way that they actually understand. An educated dancer is healthier dancer. It makes no sense to just do a series of exercises without understanding why or how they are helping. I believe you are far more likely to improve if you can see and feel how the therapy is actually benefiting you.


Let me assure you, the move to a cash based model was in no way profit driven for me. In fact, I really don't make much money from the business at all and still continue to work a full time (and sadly insurance based) job to pay my bills. I do it because I love it and believe in it. For the patients whom I have worked with, I know they have seen excellent results and don't mind paying out of pocket for a higher quality experience. Plus, if you are going to pay a co-pay (which can be upwards of $50) anyways, you might consider spending a bit extra for a service that is more individualized and truly focused on your wellness.


I should also add that in no way am I trying to bash the traditional outpatient physical therapy experience. I worked in outpatient clinics for a long time and know first hand that it is effective and will get you better. It just didn't fit with my values or work for the type of therapy that I enjoy doing. The decision is ultimately up to you, but I feel it is my responsibility to help you make well informed decisions about your health. I hope that I was able to take some of the uncertainly out of this crazy insurance world we are living in and give you something to think about next time you pull out your insurance card. 


Stay tuned... There is much more conversation to be had about this! Feel free to comment or ask me questions, I would be happy to continue to conversation :-)




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