Pros of Cash-Based Physical Therapy

Most people don't consider going to a physical therapist that is not in-network with their insurance company.   Understandably, we pay good money for health insurance and/or have it taken out of our paycheck each month.   

However, here is why it may not be the best option for our patients. 

Insurance is one of those things we hate paying for and hope to never have to use, but we are glad we have it when we do need it.  But do we have to use insurance for everything?  And should we?

Most people pay out of pocket for cash based service providers already:

   -Massage: $80-120/hour

   -Facial: $60-150/hour

   -Personal Trainer: $80-150/hour

   -Float session: $80/hour

   -Hair Extensions:  $200-$2000 

   -Eyelash Extensions: $150

I'm sure most of us have paid for at least one of these services without giving it a second thought.  It's self-care, gives people improved confidence and/or mobility, and is worth the price to us.  When we are searching for the above mentioned services, we look up best service provider. We don't want messed up lashes, an uncomfortable massage or an untested trainer. But when you look for a physical therapist who you are trusting to empower you and improve your child's mobility, where do you go? Do you only look for in-network? 

Even if you find a good service provider in network, the productivity standards, insurance requirements, limited or delayed authorization, and drive time plus co-pay costs may make it not the right choice for you and your family.  That's why cash-based physical therapy practices are becoming more common. 

Big Steps Physical Therapy does not directly accept insurances as we have decided that insurance is not the one who should dictate what is best for our patients.  We care about our patients and have a passion for what we do, therefore, our plan of cares are customized to each patient and we work with you to find what works best for your family and their goals. 

Pros of Being Cash Based:

1. One on One services with as much time as needed. Productivity standards do not decrease the focus on each patient.  There is less paperwork, less excessive standardized assessments, and no delay between evaluation and ongoing treatments. 

2. Up front clarity of billing. No need to triple check your insurance plan, calculate your co-insurance amount, count down the dollars you need to spent before reaching your deductible and wait for an invoice.  Big Steps Physical Therapy can provide you with a Good Faith Estimate with the plan of care attached and the cost of ongoing services so you can make an informed decision. No copays, no deductibles, no out-of-pocket maxes to meet (that are rarely ever met without some sort of medical catastrophe).  

3.  Clear expectations of therapy and continued communication with therapist:  Get what you pay for. No more infinite number of sessions, weekly visits forever, or lack of communication of goals.  Want to focus on therapy goals at home for a bit? Review a home program and take some time to work your goals on your own.  Our goal is to graduate your little one :)

4. Scheduling and a plan of care to fit your needs.  Does your child need to start walking as soon as possible? Are you struggling with getting those initial milestones met?  Then lets schedule an intensive program where we can solidify those skills in less than a month and not have to wait a week between each visit.  Would going to the gym for an hour once per week help you get stronger?  Can you learn a new skill by practicing for an hour a week? Probably not, so why do we accept the cookie cutter schedule of one hour per week for physical therapy?  Big Steps Physical Therapy also offers virtual sessions via GoogleMeet, clinic sessions and home visits if you are within 10 miles of 91942.

5.  In some instances, you can still bill your insurance.  Each month, or when requested, Big Steps Physical Therapy will give you a superbill with a list of all the invoices.  Depending on your insurance plan, you can submit these to insurance to get reimbursed. 

6. Start right away!  No need to wait for authorization or even a doctor referral, we have availability and can start as soon as the next day.  Per California law, we will need a doctor referral within 45 days or 12 visits, whichever comes first. We can speak to the doctor and send the evaluation if you need us to. 

You Choose

There are fantastic therapists that work in insurance-based clinics and some of you have insurance plans that would make sense for you to find and visit those therapists in those clinics. Dr. Jenny Werner, DPT has worked in insurance based centers and has worked with some incredible therapists in non-profit outpatients clinics.  However, the lower reimbursement rates and red-tape of insurance, the billing process and the pressures of productivity and paperwork reduce the freedom and effectiveness in most clinics.  

For the majority of you, cash-based providers are likely the way to go if you want to be unwavering in the goals that matter to you.  It really comes down to what you value as an individual.  

We realize that the concept is scary for some.  Believe us, the decision to become cash-based is not one that we take lightly.  However, our decision to pass up on insurance contracts means leaving the convenience of a revolving door of patients in the name of pursuing value-based treatment for our clients.  

At Big Steps Physical Therapy we want to provide care to our patients that is not dictated by billion dollar insurance companies.  We want to provide a value to our communities that operates outside of the norms of a traditional healthcare company.  We want to develop a team of therapists that are not victim to the typical causes of burnout that plague our profession.  

More understanding of insurance based care:

 Regence Blue Cross Blue Shield, Aetna, United Healthcare, and MODA all have plans that require authorization.  So while you may have 30+ visits of physical therapy allowed to you per calendar year, you are not necessarily allowed access to all of those visits whenever you like.  Even companies that are all in house (e.g. Providence, Kaiser) are requiring third-party medical necessity reviews for therapy, thereby limiting even further who you can see, when you can see them, and how often.