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How going to a cash pay PT can save you money even if you have insurance!

Updated: May 11, 2020

Cash-based PT and medical services is rapidly becoming popular. Obviously, it's what I do!

A frequent question I get is, "Do you take insurance?" I am going to explain a little more in depth as to why I don't (no soapbox) and how what I do may still benefit you.



Nowadays the medical field has become extremely profit driven. The focus of getting the patient better to getting the patient's money has drastically shifted. This is driving the costs of insurance for you or your company or both through the roof. The solution to make it more affordable is high deductibles. Seems the average deductible for my generation, individual or group plans is around $5000. This means you are responsible for $5000 before your insurance company will pay anything. Some people don't have deductibles for physical therapy but have copays which is a set price per visit the patient is responsible for- this seems to average $30 but can range from $15 to $75.


So let's do the math. Should you choose to go to a typical PT clinic- you will be asked to be seen 2-3 times per week. That's going to be $60-90 a week if you have a copay. If you have a deductible, you will have to pay outright the costs that your PT is billing. The average currently is about $33 a unit. A unit is a 15 minute segment of time- therefore your hour treatment is going to run roughly $130. (This number can vary greatly because it is based on the contract your insurance company set up with that provider.) Many insurance companies have visit limits as well- meaning you may get 8 visits per year or 30 per year- then once you are done- sorry bout ya. Not cool.


That same clinic has a set up most likely (as in 99% of the time) with 3-4 patients scheduled under the same clinician each hour. You will get 20-30 minutes of direct PT time, at most while be juggled with other patients. You however need to be in the clinic at least 53 minutes for them to get the most money so you may be guided through some exercises (likely your home stuff) by a tech (most likely a high school student). Now, I am not saying your home exercises aren't important or that you don't need to review them with someone, but that should be your PT and they should be regularly updated and progressed.


With cash-pay PT, you pay a flat rate. You will know that rate before you walk in the door (Hint: it's less than $130). You will likely be seen once a week with the expectation to do your exercises between. You get one-on-one with your PT for an average of an hour. Your PT and you set your goals and the duration you need to be seen, not your insurance. So for roughly the same price or maybe even less, you get one-on-one care with someone who is listening to you and adjusting each exercise based on you, not juggling 3 other people at the same time.


Now, is cash-pay always the answer...no, of course not. If you have insurance that covers 100% then sure utilize it. Will you get quality care? It is possible. Not all PTs at mill-type clinics are awful...many of them are great PTs. It is not them that is the problem, it's the system and they are just doing their best in it.


My advice, look at your insurance benefits...compare them? Call Body Fix 180 and compare its price to what you may pay elsewhere. If you have insurance that provides you with out of network benefits, then guess what, they will pay for Body Fix 180! Win win! If you still aren't sure, call Body Fix 180 and request an insurance work-up sheet. It can lead you to ask your insurance company the right questions to determine what is best for you!


If your insurance is so-so and you are looking for someone who understands your needs and goals- who won't tell you to stop running or don't lift weight if it hurts or understands the demands of high school sports and the desire to get back out there as soon as possible- then call Body Fix 180 for a free phone consult. Get your questions answered and choose the option that best suits you, not your insurance!!!



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