Receptionist Speaking With Patient About The Role of Insurance In A Physical Therapy PracticeOne of the most common questions potential patients ask when they call our office is, “Do you take my insurance?” When we tell them that we are an out-of-network, cash-based service provider, many of them hear “no” and hang up.

However, our Virginia sports physical therapist adds, our response is far from “no” and much closer to “maybe, but either way, you’ll save money and feel better than with traditional insurance-based PT.” Maybe because it takes longer to say (or because they already hung up), people are resistant to using cash-based medical services.

We want to take a minute to explain why we’ve chosen this model for our practitioners and our patients. At SPARK Physiotherapy, it doesn’t matter who your insurance carrier is, where you live, how much your co-pay is, or whether you met your deductible.

We don’t believe that your medical treatment should be controlled by what an insurance company will or will not pay for.

What Does My Insurance Pay for if I See an In-Network Provider?

This is an important question because the answer complicates the care that most people receive when using insurance-based PT services. Even after you’ve found a provider that accepts your insurance, you’ll soon find that there are limitations on the types of services covered.

For example, say you have vision insurance through your employer. You call up your preferred optometrist, but they don't take your insurance. After a few more calls, you find an optometrist who will—great!—but you must wait for the next open appointment, which is two months away.

Once you’ve waited all that time, the doctor performs several tests and gives you a prescription for eyeglasses. You’d rather have contacts, but insurance only covers half of what they cost, and glasses are free.

After an hour of choosing comfortable, attractive frames, you’re told that they actually aren’t 100% covered—only the ones on the first rack are. Oh, and one of the tests that the doctor ordered isn’t covered by insurance, so you’ll have to pay out of pocket for it. In the end, you choose between paying more for something you want and paying less for something that’s just ok. Either way, neither is “free.”

This is how health care is run under the insurance companies. If people have insurance, they believe it’s always best to use it—and in fairness, that’s how it should be. Unfortunately, providers treat patients based on how much money they receive from the insurance company.

For physical therapy patients, this means they only get as much care as their insurer pays for. If the company doesn’t pay for a treatment, it isn’t given—regardless of whether the patient would benefit from it.

How Is My Experience Different With Direct-Pay PT?

Appointments in insurance-based PT are typically stacked with three or four patients at once, giving you the choice of being treated in a group or on your own with an untrained technician. You might see a professional, but likely not for more than 15 minutes—because that’s the minimum patient care that allows for maximum billing.

The SPARK business model puts control of care back in the patient’s hands. Professionals in a cash practice are dealing with one payment source: YOU. You have paid for your hour, and we are seeing just you, one-on-one, and fitting as much treatment as possible into each of your sessions.

Is Paying Out-of-Pocket More Cost-Effective for Me?

Surprisingly, yes. However, it depends on how much you pay for insurance and how much you’ve been paying for treatments that haven’t worked. Let’s say you hurt your shoulder and paid a $15 copay to see a physical therapist twice a week for the last month.

You still haven’t recovered—probably because you spent 60 minutes total with a medical professional in all that time—plus you left work early from the pain and bought some over-the-counter treatments to cope.

Or, you could spend the same amount of 60 minutes with a professional physiotherapist at SPARK. You and your therapist work together for the full session, discussing your needs and goals regarding your injury—including how to ease the pain so you can work. You leave with an exercise regimen tailored to your condition and advice on the most effective way to strengthen without risking re-injury. A few weeks later, you’re back to normal activities—plus, you’ve gotten a reimbursement check from your insurer!

Is There a Way to Use My Insurance and Still Get the Results I Want?

Yes! That’s the incredible thing about our services; if you have out-of-network insurance benefits, we will submit a claim for your treatment to your provider on your behalf. On average, clients receive between 60% to 80% of their claims back, giving them a one-on-one PT session for about the same as the co-insurance they would have paid at an in-network clinic. If you’re entitled to reimbursement under your policy, you have control over your care AND a means of paying for some or all of your treatment in our clinic.

Dr. Carlos J. Berio
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D.P.T. Doctor of Physical Therapy in Virginia