with Dr. Cody Clayton Gardner, PT, DPT, CSCS
At SYZYGY Movement Solutions, we don’t accept insurance.
Yes, you read that right. And here we will explain why. The short answer—everyone wins.
Let’s see if this sounds familiar.
You start PT at a traditional, insurance-based clinic. You walk in with a script from a doctor saying that you should attend three times per week for six to eight weeks. You hand that script to the front desk worker and they tell you your copay will be $40 per session. So you pay the amount, and you start therapy. You go in for your evaluation, which feels rushed. You have so many questions that the doctor didn’t really address, but the therapist says they’ll explain it all as you go. Before the end of your evaluation, the therapist hands you a packet of ten exercises with directions and may briefly demonstrate them for you with no explanation of why—only that you should do them three times a day, with three sets of ten repetitions each.
You go in for your first follow-up session and realize your therapist will be seeing a few other patients at the same time as you. Actually, the therapist is nowhere to be seen; only an Exercise Science student from the local University who makes you do the same exact exercises that the therapist had you do in the first place. The therapist comes to do a little hands-on work, and it’s not even the same therapist. You still want your questions answered, but you really don’t feel like you can because the student doesn’t know much and the therapist wasn’t the one who evaluated you. You just hope that this therapist read your chart well enough. Forty minutes after you arrive, you walk out feeling a little better, but just as confused and left with the lingering prospect of having to fork over $40 more twice more this week.
This is an all-too-familiar reality in the physical therapy world. And you know what? It’s not even the therapists’ fault!
There are 7 chief reasons why cash-based / out-of-network physical therapy is superior.
1) You get better care.
Traditional physical therapy clinics get paid by insurance companies. Yes, you may fork over that $40 per session, but the full value of that treatment session may be in the hundreds of dollars. The remainder of the cost of the session gets paid by the insurance company (or you, as co-insurance). But here’s the kicker: because the insurance company takes credit for “bringing you” to the clinic, they only reimburse the clinic for a small percentage of the full amount.
That amount has been decreasing more and more every year for the past 20 years or so. So every year, clinics have less and less resources to keep their doors open. As a result of narrowing financial margins, clinics have adapted to focus less on the patient and instead on how many patients they can get in the door—hence, physical therapy techs and assistants, less face-to-face time with the therapist, and shorter sessions.
In a cash-based setting, insurance companies don’t determine how much the therapist gets paid—so the therapists can take as much time, effort, and instructing as they need to ensure high quality care for their patients. We realize and expect that you are a real patient with real-world problems, and we plan your care with these in mind.
The insurance company doesn’t dictate what treatments we can and can’t do: after all, the physical therapist is the one with a doctorate-level education and knows what the evidence says about what does and doesn’t work.
2) It’s not as time-consuming.
Evidence shows that spending one hour a week in high-quality physical therapy can equal, if not surpass, the results from three 30-minute sessions in a traditional, high-volume clinic setting.
What does this mean for you? Less extra-long lunch breaks where you’re rushing to and from therapy without actually eating. Fewer copays. Less stress. Less transportation costs.
Why does this happen? With a continuous hour of skilled therapy, you don’t waste as much time on warmups, soft tissue work, and ice/e-stim; and you instead capitalize on that time on your specific needs and the things that really matter. Which brings me to my next point.
3) You may end up actually paying less.
Let’s break it down with the same hypothetical we just laid out (3x/week for 6 weeks):
TRADITIONAL PHYSICAL THERAPY
Co-pay: $40
Number of Visits: 18
Total Cost: $720
Time Spent with PT (10 min per 40-min visit): 180 minutes
Cost per minute: $4.00
CASH-BASED PHYSICAL THERAPY
Cost per visit: $140 (less with bundling)
Number of Visits: 6
Total Cost: $840 (less with bundling)
Time Spent with PT: 360 minutes
Cost per minute: $2.33
As detailed above, you would actually spend twice the amount of time with the physical therapist and pay almost half the price for it in a cash-based setting!
Costs would be even less if you purchased a bundle of visits—a much more common practice in cash-based PT and virtually unheard-of in the insurance-based world. You would pay even less if you manage to be reimbursed by your private insurance for out-of-network coverage (for more detail, see Reason #6).
4) A shift occurs from confused consumer to empowered collaborator.
Sleeping positions, how to hold your baby, how to properly arabesque in ballet, how to properly warm up for your bike commute, how to set up your ergonomics in your home office… These are the things we really want to know.
With the ample, continuous time allotted in cash-based care, you spend more time learning about your body and how to treat yourself.
After all, a successful episode of physical therapy isn’t just becoming pain-free, but also never having to come back because you know how to prevent this issue from debilitating you again.
5) Your therapist has enough time to get to know you, your specific issues, and how you tick.
The really messed up part about insurance-based care is that they don’t reimburse physical therapists for one of the most important parts of a successful plan of care: talking. To an insurance company, if a PT isn’t doing something to you, they don’t get paid for it. So clinics make efforts to combine or shorten that time getting to know you, bond with you, and teach you.
Did you know that up to 75-80% of your chances of succeeding in physical therapy has nothing to do with what exercises you do or manual therapy techniques are done? It's true! The majority of the factors that determine whether you get better—the insurance company doesn’t care about.
With more freedom in working with a cash-based therapist, they can treat you as you should be treated: a person, not a condition. This kind of depth can give your PT insight on how to better help you, considering your strengths, weaknesses, psychology, motivators, barriers, and values.
6) You may still be able to use your insurance.
Cash-based physical therapy practices do not establish contracts with insurance companies. Essentially, cash-based practices have no agreement with insurance companies for them covering your care at the time of therapy. However, this doesn’t mean a private insurance company won’t cover you at all for cash-based healthcare!
This is done through “out-of-network coverage.” Ring a bell? Right! This is the same thing as when you want to see a doctor that doesn't take your insurance or is listed as an “out-of-network” provider!
You have but to ask your cash-based therapist for a copy of your note for the day. Cash-based PT’s still have Medicare NPIs, Tax ID Numbers, and use CPT codes; the same checklist that insurance-based practices need to bill the insurance company. You may be able to send that note to your private insurance as a claim and be reimbursed for the difference of your out-of-network rate for your specific insurance plan.
However, be sure to check with your private insurance provider to see if they participate in this program before you plan on submitting a claim!
The only difference between this and the standard “in-network” model is that you end up paying an out-of-network copay rate (as opposed to the in-network copay), and the physical therapist is guaranteed to get paid what they deserve!
7) Your doctor of physical therapy gets equitable compensation.
Ever hear of the motivational life-coach and entrepreneur, Tim Feriss? In his New York Times bestseller, The 4-Hour Work Week, he asserts that humanity’s relationship with money has changed. In today’s world, money is merely the means to achieve the things we want in life. He further explains that the currency of today’s world isn't money, but freedom—the freedom to pursue the things we really want to achieve.
Owners of cash-based practices are tired of the constraints and failures of the insurance-based model of PT. That’s why they got out in the first place! Cash-based therapists are visionaries—practitioners who want to explore how best to serve the needs of the public that aren’t satisfied by the current system.
When you invest in yourself and your health with a cash-based PT, the PT gets the revenue—not the insurance company. You are investing in the freedom to pursue exciting ideas and innovations the business has for pushing the envelope of what is possible in physical therapy!
Life is movement! Helping your physical therapist helps them, in turn, give life to your years.