Frequently Asked Questions for Physical Therapy
Do you bill PT services based on what interventions you provide or based on time?
My fees are based solely on time. After working in health care for 6 years, sadly I believe many health care providers’ clinical decisions may be influenced consciously or sub-consciously when their pay check is tied to what interventions they provide. I will not allow this to be the case in my practice. I do not want the possibility of money influencing my clinical decisions. When people are my business, people need to be my priority. I believe if I treat people to the best of my ability, I will help people get better, the patients will be happy, and the business will take care of itself.
Why are you “out of network” and what does this mean?
The choice to go “out of network” was to allow me to practice physical therapy the way I thought I could best serve my patients. Often the insurance company will limit the number of visits a patient can be seen and also can determine what billed units will be reimbursed. Furthermore, if a patient has yet to meet their deductible, inflated charges from physical therapy are passed from the insurance company to the patient who may get stuck with a $400-$500 bill for one visit. I wanted to cut out the middle man (i.e. insurance companies) so the contractual relationship is between myself and the patient. I want the patient to know exactly what treatment they are receiving, why, and how much it is going to cost them. Removing insurance companies from the picture allows me to operate with lower overhead costs (no billing/collections department) so I don’t need a “factory line” clinic to make ends meet. Additionally, it allows me to bill accordingly for my services rather than negotiating and accepting a reduced rate to be coined “in-network”. This allows me to work with patients one on one instead of having to increase cash flow by increasing the number of patients at one time.
Can I use my HSA (Health Savings Account) to pay for your PT services?
I’ll try to keep this answer short… Yes.
Does “out of network” mean I will be billed for your services?
This is a loaded question. So read the full response. Yes, you will have to pay the cost up front as I do not bill your insurance company. However, I will give you a claims form so you can submit this claim to your insurance company. If you have met your deductible, and depending on your coverage for physical therapy, the insurance company will reimburse you for your charges. If you have not met your deductible, this claim will be applied towards your deductible. Again, the specific amount you are reimbursed will depend on your plan’s physical therapy coverage so check with your insurance agent. You can pay with debit/credit/HSA/Flex cards or cash.
Why should I front money for PT when my insurance will pay for an “in-network” provider?
Many PT clinics are billing roughly $400-$500 and collecting $100+ per physical therapy visit. In addition to this, many patients have a copay between $10-$40 per visit that does not apply towards their deductible. If the deductible has not been met, although insurance is billed, the insurance company will pass the bill along to the patient who is unaware of the costs accrued while receiving PT services. Let’s say for ease of math, it is on the cheap end and they are billed roughly $100/visit and paid a $10 copay everytime they went in. This means the patient spent $110 per visit and likely was treated with 2 to 5 other patients at the same time. For an additional $10 a visit ($120/hour rate I charge), they could have spent an entire hour one on one with their PT, likely gotten better a whole lot faster with more focused and specialized care, and saved money with reduced number of visits.
In the circumstance the patient’s deductible is met and they do not have a copay for PT, it is still advantageous for them to pay upfront rather than go to an “in-network” provider. The patient will be reimbursed according to their selected health plans coverage for out of network providers. Furthermore, the patient will work one on one with their PT for an hour. This allows for more focused and directed care and optimal development of self management techniques. No typical “in-network” physical therapy provider can guarantee this one on one care.
What is so specialized about PT? Isn’t it just a bunch of exercise? Can’t I just look up some exercises on youtube?
Well, I will not hate on youtube university as it is a great tool, but, this approach may leave you worse off than you started. Exercise is like cooking or baking. Better stated, it is like being the ginger bread man and trying to bake yourself. In exercise and baking, it is not what you do, but how you do it. Many people can make the same food or even use the same recipe and it can taste completely different. The difference may be in whisking instead of stirring, order of adding ingredients, how long something should marinate… Exercise is the same way. An optimal progression and order exists with an ideal biomechanical position and neuromuscular activation pattern. If someone tells you otherwise they are uninformed, uneducated, or lazy and lying to you. Even if you don’t work with us, I encourage you to find someone who is a specialist with a philosophical approach based on science and clinical experience. You will thank yourself later for it.
Frequently Asked Questions for Performance/Training
How do you determine your pricing?
When you pay for training you are not just paying for the one hour to workout with me. Actually, the one hour of working out is the easy part for me! The hardest part is the program design…and the most time consuming. Designing one cycle of workouts anywhere from 4 to 10 weeks can take me between 2 to 5 hours to design. I am also continually progressing your workouts by re-designing during your 4-10 week cycles. On top of programming I am always doing some type of continuing education courses to better serve my clients. These courses cost anywhere from $500 to $2000 per course and that is not including travel, food, and stay.
Why do we have to sign a cancellation policy?
Cancellation policies are made to hold you more accountable. Remember that when you are scheduled, you are taking up an entire hour. If you no show, that is an hour lost where I could have been helping someone else. Emergencies like being sick, a death of a friend or family member, or other extreme circumstances will not be charged. But, if you are constantly missing due to being too tired or other poor excuses, you will be charged.
Why are single session’s more expensive than packaged sessions?
Drop in sessions are more expensive due to rushed program design. Purchasing single sessions are for clients who want to come in once a month or once every couple of weeks. When increasing the volume of training with me I decrease my prices to make it more affordable. I also put a time limit on them to hold you more accountable.