MKE PT is a Direct Care Physical Therapy clinic. When you choose to receive treatment from me, you’re choosing to remove insurance companies and their inflated costs and restrictive policies from your healthcare equation. This concept is unfamiliar to many and can cause confusion. Common questions are: “How could this work?” “Why would people pay cash out-of-pocket for PT when they already pay for insurance?” “Is it ethical?” “Is it legal?”
It is understandable that someone would be confused by the concept of cash-based healthcare services. The reality is that in the current healthcare environment, a patient can receive superior care and often save money by paying out-of-pocket, directly to their provider. Many people are indirectly paying for therapy at a higher rate without even realizing it. How is that ethical or legal?
When I go to see my doctor, they ask me who my provider is. They’re asking for my insurance company. When does an insurance company provide educated, evidenced-based care? It’s time to start looking at our doctors, nurses, and therapists as providers and our insurance company as a facilitator of that care. Health insurance policies are increasingly falling short and have limited tools left in their toolbox to facilitate your health care needs. Direct Care services such as MKE PT aim to change this paradigm.
What are the cost benefits of Direct Care Physical Therapy?
Ask yourself these questions:
- How much do you value your health?
- Are you unable to do what you enjoy most because of pain and weakness?
- Are you ok with your insurance company dictating the care you receive?
- Do you want to participate in your own healing process?
When you see a PT through the traditional insurance model, you are likely paying more than you realize. With the Center for Medicare and Medicaid Services’ (CMS) recently finalized new regulations regarding Price Transparency, patients are now able to see how much their services will cost before their care is given, and the numbers are shocking. Here is a chart that shows typical costs through an insurance company before a high deductible is met, vs MKE Physical Therapy costs.
It is important to note that the typical treatment time for Physical Therapy visits in a hospital or clinic is between 30-45 minutes. This limits the amount of manual therapy work and exercise/activity instruction possible to provide thorough care, which will require more visits. Through MKE Physical Therapy, the follow-up visits are a comprehensive 60 minute session, which will require fewer follow-up visits.
In 2020, the average national cost for health insurance is $456 for an individual and $1,152 for a family per month. And in 2020, the average annual deductible for single, individual coverage is $4,364 and $8,439 for family coverage. Based on these numbers, an individual could end up directly paying over $4,000 for PT before their insurance kicks in.
In my 15 years as a practicing Doctor of Physical Therapy, I have seen the pressure on therapists to bill more and treat less get stronger every year. Let’s look at what a 45 minute treatment looks like in the insurance-based world. Forty-five minutes means 3 billable time-based units. To bill 3 units, a patient must be seen anywhere between 38 and 52 minutes. Yes, you are allowed 52 minutes of care! However their appointments are put in back to back 45 minutes slots and PTs are encouraged to treat for the minimum of 38 minutes and spend the remaining 7 minutes writing lengthy notes to appease insurance companies, followed by time spent cleaning their treatment room. So, now what does this mean to you? You are cheated out of 14 minutes of care!
To further complicate health care costs, there is a rising number of patients that are required to contribute co-pays for each visit. I have seen co-pays ranging from $10-$100 per visit. If a patient is seen for the typical 12 visits of PT, they are charged an additional $120-$1200 in co-pays.
What are the care benefits of Direct Care Physical Therapy?
As a passionate PT, I pride myself in positive outcomes, and my goal is to provide the best care possible. The restrictions imposed by insurance companies add a barrier to that goal. Freed from those restrictions, I can build a cohesive and collaborative relationship with each of my clients to ensure positive and empowering outcomes. As the provider, I can place all of my focus on the client, and remove the impediments to care that are imposed by insurance company red tape. It means you receive treatment from a provider that is 100% focused on you. This is the way to better care and better results.
