• Nashville PT

Surprise Bills? No Thank You!

(By: Christi Williams)



When you go to the doctor, or other healthcare provider, and you use your insurance, how often do you know exactly what the cost of your visit is going to be BEFORE you arrive? Even if you ask, the typical response will be something along the lines of, "It will vary depending on what your insurance covers.”


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So, being the responsible person you are, you call your insurance company, and they say, “It depends on what codes your doctor bills.”


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You assume all will be fine and you go to your appointment. I mean, what else are you going to do when no one can answer the simple question for you?


We all know what happens next. About 1-2 months later, you get the mysterious bill in the mail. At this point, it has been a long enough period of time since you were at the appointment, that you hardly even remember being there! You tentatively open the envelope because, let’s face it, you have no idea what you’re on the hook for. Then, “surprise!” you are the lucky recipient of a bill for $300 for an appointment you hardly remember! Well, dang! So much for planning accordingly.


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This happened to me recently and I was quickly reminded how much of an annoyance this “process” really is. I don’t think any of us would go to a store and buy items never knowing the cost of the items until the bill came in the mail. Instead, we would weigh our decision of purchasing or investing in the item along with the cost of it. Right? Isn’t that part of what goes into making decisions about HOW you invest your money, or in choosing WHERE you invest your money? So why do we continuously accept the surprise bill as “normal” practice when it comes to investing in our healthcare?


Personally, I prefer to know the cost of my care upfront. It removes all the wonder, waiting and worrying. I HATE surprise bills, so anytime I can avoid them and pay upfront, I prefer to do so. That way I can make informed decisions about where I choose to seek my care and also plan my spending accordingly.


At Nashville PT, we believe in full transparency. You will know your cost of care up front and never, ever have a surprise bill in the mail months later. We can provide this information because we are out of network with health insurance companies.


It’s the insurance companies that are responsible for the “mystery” in everything. We don’t like the game healthcare providers have to play by marking things up. They know insurance will not pay the full amount, so they must adjust their costs accordingly.


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We are simply bottom-line people at Nashville PT. We don’t play the game. We just tell you exactly what the cost will be and exactly what to expect with your appointment. It’s just easier that way.


I had a patient earlier this year who started physical therapy with another company. He went to only 2 sessions and decided to look elsewhere because he only got about 15 minutes with the PT when he was in the clinic. The other time was spent walking on a treadmill and working with support staff. He wasn’t getting his questions answered and he didn’t understand the plan of care and what the process would look like to obtain his goals. The facility that he was going to was “in network” with his insurance – at least that’s what he was told. He asked what the cost would be before he started, but wasn’t able to obtain a clear answer.


After feeling frustrated at his 2nd visit because he received very little time with the physical therapist, he searched online for PT clinics who have one-on-one care. That is how he found Nashville Physical Therapy & Performance!


When he first came in, he noted that he was not seeing any improvements in the 2 sessions he had at the other facility and wanted more specific care. Guess what? After 2 sessions at our facility, he was nearly pain-free! The difference?


1. One-on-one care which meant more time per session with the PT and fewer sessions


2. Full understanding of his plan of care and WHY we were doing the things we were doing


3. No surprises - he knew exactly what the cost of his care would be


Not only did he have a clear understanding of the cost of his care, but the price was substantially less expensive. At one of his later sessions, he informed me that he finally received a bill in the mail from the previous facility for a total of $900.00!!! And his insurance was covering only $200.00, which meant his surprise bill was a lovely $700.00 for only 2 sessions of PT!! And the kicker was that he didn’t see any improvements with the $700.00 care, but was nearly pain free in only 2 sessions with NPT with less than half the cost. God only knows what his bill would have been if he had done more sessions with the first provider before he had gotten his first surprise bill in the mail… he would have been out thousands of dollars!


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Thankfully he decided early that quality of care was super important to him and he decided to seek a place with greater value – both in quality of care / time spend with the therapist, and, as it turned out, greater value in the cost of care as well!


Stories like this literally make my stomach turn, and they remind me why we do things the way we do at Nashville PT. I don’t EVER want to be the one responsible for the mysterious bill that gets sent in the mail to some unexpecting person months later.


What’s the take-home message here?


1. Out-of-network providers can provide care that is not dictated by what insurance reimburses. That’s why they remain out of network – it provides freedom to care for the patient in the best possible way. Oh, and they don’t have to mark up their prices playing the insurance game, so the mystery of the cost of care goes away.


2. Out-of-network providers are not necessarily going to cost more. Also, because you have more quality time at each session, usually there are fewer sessions needed to make lasting changes. Therefore, your cost of care is often much cheaper in the long run with less of your time spent running to and from multiple appointments in a week.


3. It pays to understand your insurance policy. If you have a high deductible plan, it is likely that you will owe the full amount of the cost of your care for every session. If that’s the case, seeking the highest quality of care is a no-brainer.


4. It is ok to ask about the cost of your care before it’s too late and you receive the mysterious bill in the mail. While you may not get a direct answer, someone should be able to give you an estimate.


If you have more questions or want to schedule an appointment, you can call or text us at 615-428-9213 or schedule online from our website homepage.

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