A New Physical Therapy Model
When I set up ProMotion Physical Therapy, I had to decide on the the type of physical therapy business I wanted to create for my patients. The most common arrangement, and the one that most people are familiar with, was for me to be “in-network” with insurance companies. In this arrangement, I would sign a contract with the insurance companies and agree to their fees as well as any limits that they set on number of visits that I see patients, what I could see them for, and the type of treatments that I could use. [...]
When I set up ProMotion Physical Therapy, I had to decide on the the type of physical therapy business I wanted to create for my patients. The most common arrangement, and the one that most people are familiar with, was for me to be “in-network” with insurance companies. In this arrangement, I would sign a contract with the insurance companies and agree to their fees as well as any limits that they set on number of visits that
I see patients, what I could see them for, and the type of treatments that I could use. The other option was to set up what is known as a “concierge” physical therapy clinic (also known as an out-of network or non-contracted clinic). In this set up, I do not bill insurance or sign a contract with them and therefore, am not limited by the restraints the insurance contract in deciding how I treat my patients. I knew that I wanted to offer something different to patients that would allow me to provide the best care possible in a time and cost efficient way.
Eventually, I decided on the “concierge” or “out-of-network” set up. What this means is that people can use their insurance in my clinic, but I am not contracted with the insurance company. Now, many people are not accustomed to this or not aware of how this works. So, I would like to explain a bit more about this and why I feel this is best for the patients I work with.
1. More Time Per Visit With Each Patient. For the past 22 years, I have worked in settings that were “in-network” with insurance companies. In order to bill insurance, these settings needed to employ a designated billing and collections staff. More staff means more overhead expense. More expense means that rates need to be higher. Combine this with the fact that most insurance contracted reimbursement rates are not very good for physical therapy and you end up being able to spend less time with patients per visit. These companies need to get more patients in and out per hour to cover their expenses. This may end up meaning that visits are limited to 15-30 minutes each. I did not want to work in this type of setting any longer. Over my years of treating this way, I realized that I could help patients more if I was able to spend more time with them at each visit. I have now been able to set up my clinic so that I can work with each patient for an hour in order to help them make as much improvement as possible at each visit.
2. Patients Get The Visits They Need: Once a contract is signed with an insurance company, those clinics need to follow the insurance’s rules. When I was working in an in-network setting, I became more and more frustrated by the limitations in visits being placed on the care that patients can receive. The amount of care that was able to be provided to the patient was being determined by the insurance company and not the patient and therapist. I found that patients had to be “discharged” from therapy not because they had improved as much as they wanted, but because the insurance said that no more visits were needed or approved.
Being a non-contracted clinic, how long or how many visits a patient will be seen is determined cooperatively by me and my patient only. Treatment can be continued until the patient feels that they are able to do the things that they previously couldn’t or are doing things a lot better than they used to.
Now, for the most part, seeing patients for an hour at each session has resulted in them improving and getting back to the things they enjoy with fewer total physical therapy visits than if they have had shorter sessions. However, in some situations things take a little longer and it is good to know that I can work with my patients as long as they feel they need me and that I am helping them.
3. Premiums, Deductible, and Co-Pays: You likely have noticed that health insurance is getting more expensive every year. Many of you are paying more for your premiums (monthly payments to have insurance) while at the same time finding out that your insurance may be covering less or requiring you to pay more. A deductible is the amount that you have to pay out of your own pocket before your insurance covers anything. In an effort to lessen premiums, more people and businesses have health plans with high deductibles. How does this relate to needing therapy? If your deductible is not met, you will be paying for therapy out of your own pocket whether you go to an in-network or out of network therapy clinic. In essence, you are paying cash for your treatment.
My clinic is not big, and I do not have a secretary or need a billing staff. This allows me to keep my overhead expenses low and results in fees for therapy sessions that are much less than many of the other physical therapy options here in town. If you are paying out of pocket because your deductible is high or not met yet, having therapy at my clinic will actually cost you less than going to your in-network option. If you are unsure about this and need therapy, call around and ask about pricing for hour long therapy sessions (if that is even offered).
Beside deductibles, the other thing that is becoming more common and something to consider is co-pays. Some insurance plans require you to pay a fee each time you have a visit. These can range from $25 all the way up to $75. This fee is the same no matter if you are seen for 15, 30, or 60 minutes. This can add up quickly if you are being seen for only 20-30 minutes per visit and 2-3 times per week. Because I do hour long treatment sessions, I usually do not need to see people more than 1x per week. So, not only will a patient get more treatment time per co-pay, the number of co-pays they will have to pay will be less as in most cases, they are seen for fewer visits.
4. Insurance Can Still Be Used: As a non-contracted insurance therapy clinic, I am paid by you, the patient. This can be done at each visit, as a package, or in agreed upon payment plans. Payment can be made by cash, check, credit card, or use of a health savings account. This however, does not mean that you cannot use your insurance at all. If you request it, I can give you what is called a “super-bill” which includes all of the diagnosis and billing codes as well as information about my business that you need to get reimbursement from your insurance company. Your insurance company will then reimburse you a portion of the amount you paid for the therapy treatments. This is a good option if your out of network deductible is met. The exact amount you will get reimbursed will depend on your out of network benefits and varies by plan. Again, if you have questions about this and want to know how much sessions will actually cost you by using your insurance, you can contact me and I can check your insurance for you.
5. This Is Not New: Concierge, out-of network, or non-contracted physical therapy is not new. There are many therapy clinics throughout the U.S. that are caring for people with this treatment model for the same reasons that I stated above. Therapists get to treat the way they want, and patients/consumers are becoming more savvy with how they spend their healthcare dollars so that they receive the care that they deserve and see the value in.
6. I Just Enjoy Working with and Helping People: This is probably the main reason that my clinic is not in-network with insurance companies. I just want to spend time doing all I can to help people do the things that they want to do better. I want to do this on mine and the patient’s terms, not the insurance company’s. I want to be able to spend my time and energy focusing on the needs of the person I am helping and not on doing a ton of paperwork, making multiple phone calls, arguing with insurance about treatments being done or number of visits planned. I just want to help people the best I can. My experiences over my 22 years as a therapist, has allowed me to set up ProMotion in a way that I strongly believe is the best way for me to do this.
If you are struggling with doing the things you want to be able to do because of some sort of physical problem and want to learn how I can help and how this treatment model can benefit you, please feel free to email me of give me a call, and I would be happy to discuss this with you in more detail.
Thanks for reading,
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