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  • Writer's pictureNashville PT

Why choose an out-of-network or cash based PT practice?

Updated: Dec 10, 2020

You have health insurance that you pay for every month. So why should you go out-of-network or choose to pay cash instead for your physical therapy? There are actually many benefits to doing so and we want to tell you about them.

1) One-on-one time with your PT

PT offices are usually quite busy. You see large rooms filled with endless tables and endless patients. Typically, there aren't the same number of PT's as there are patients. You can do the math or we can just give you the answer - most PT clinics have their PT's see multiple patients at the same time, usually only giving each patient a fraction of their hour appointment spent with the PT. That means your entire appointment isn't just for you.

When you go out-of-network or cash pay, that drastically limits the overhead usually involved with billing insurance as well as low reimbursement that drives many clinics to be forced to see multiple patients at once.

We only see 1 patient per PT at a time. That means when you come in for your appointment, it's just you and your PT for the entire appointment. That increase in time spent with your PT cuts down on the number of visits you need overall because you can accomplish so much more in a single session.

2) Who's providing your treatment while you're in the clinic - a PT or support staff?

A lot of busy clinics employ support staff to assist with your physical therapy treatment. This further decreases the amount of quality time you get to spend with your physical therapist and having to switch between multiple people during a treatment session diminishes the continuity of care from your provider.

At Nashville PT, we are ALL physical therapists. We work as a team to support one another and we do not hire support staff who are not skilled clinicians. Even when you call our office, you will speak to a PT! Your entire appointment is spent with your PT only and you won't get shuffled around to another person. This means you get educated throughout your treatment, can have adjustments made on the fly as needed, and always have the most highly skilled therapy eye on you during your treatment to ensure you're doing everything right and getting the most out of your visits.

3) Insurance limitations

Insurance. It's a tricky thing. It's usually a good thing but not always when it comes to PT. We'll let you in a little secret - insurance companies are not non-profit organizations and they don't always have a patient's best interest in mind.

While patients can see a PT without a referral, there are still quite a few insurance plans that do require a referral or worse, an authorization, meaning you can't start treatment until they say you can.

Many plans also have visit limits or markers that when you meet them, they won't cover any more visits, the fact that you may not have reached your ultimate goal (think meeting full range of motion or other measures but maybe you still have pain with running or weight lifting despite having full range of motion).

Also, what about that insurance plan that's supposed to cover health care costs and you just pay a copay or coinsurance payment? That's great, but there's this thing called a deductible that you have to meet and in most plans, PT is a covered service but only after the deductible has been met meaning you're paying full price out of pocket anyway until you reach that $3000, $4000 or $5000 deductible (some are even higher than that!).

We believe that we (your PT and you) should be the ones making decisions about your PT care, not your insurance company. That's why we choose to go out-of-network.

4) How often do you need to go to PT?

Have you been to PT before? How many times a week did you have to go? 2? 3? Now how many weeks did you have to go? 6? 8? 12? That could end up totaling as many as 36 visits (assuming your insurance doesn't cut you off before that).

With a cash pay model, because of the complete 1:1 time with your PT, you usually need far fewer visits. Many of our patients only need to come once a week and our average number of visits overall for a plan of care (or a course of treatment for a certain injury/pain/dysfunction) is about 5-6 visits. What sounds better, 5-6 visits or double digit visits?

We work to make sure that you understand what you need to be doing on your own at home in order to get better. Yes, that means homework, but you'll also have the understanding of why it's so important and how coming to PT doesn't necessarily mean having to stop doing your favorite activities. And not to mention, fewer visits overall means less time away from work, fewer times of having to schedule a babysitter and less time sitting in traffic!

5) How easy is it to reach your PT if you have a question?

If you go to a big PT practice and you have a question in between sessions, chances are you'll have to call and leave a message with someone at the front desk and then wait for a call back before you get your answer.

Part of our model is having open communication with our patients, even between sessions. You can reach us anytime between appointment through email, a direct message through the patient portal, or a call or text message. We welcome it!

6) Is your PT visit full of passive things you could do at home?

You go into your session, see your PT for a few minutes, do some exercises with a support staff supervising, and then sit on some heat or ice or e-stim for the last 15 minutes of your visit.

Can't you just heat or ice at home? Yes, you can. And that's exactly when you should do it if you need to. While it might feel good to sit there on those passive modalities, they ultimately won't fix you. Don't you want your appointment spent doing the things that will actually address your problem and fix it? Those are things like exercise, manual therapy and education.

We don't use any passive modalities in our practice because we believe your valuable time and money are better spent doing the things that will make a lasting change and fix your problem, not just put a temporary feel good band-aid on it.

7) Can you get wellness, preventative or injury prevention visits?

Unlike the annual check-up by your physician, most insurance companies do not cover musculoskeletal wellness or injury prevention by a physical therapist. This is why you typically do not find any wellness services at large outpatient practices.

However, those services are incredibly important. It is MUCH less expensive to prevent injuries than to treat them once they have occurred. It's also less time missed doing your favorite things if you can prevent them as well. We would much rather work with patients on getting strong and mobile and preventing injuries instead of treating them after an injury has occurred.

You have annual physicals with your MD, you take your car in for maintenance to prevent engine failure, you might even do preventative services on your HVAC unit at your house to prevent costly repairs in the future. Why wouldn't you do the same for your body?!

We offer wellness, maintenance and injury prevention services to keep all our patients healthy and happy.

We know if can be hard to understand why you should forgo your insurance benefits to pay out of pocket for PT services. Hopefully this information was helpful to understand the benefits of doing so. We want to provide the best care and get the quickest positive outcome so you can return to your favorite activities as fast as possible!

If you've been to PT before and it "didn't work" or you felt like it was a waste of time, try us and see how we're different.

If you're still not sure, you can see what our patients are saying about us and our way of treatment on Google. Click here!

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