How I Ended Up a Business Owner/Why Cash-Based PT

Why cash-based care?

Since branching out on our own, my business partner and I have extensively discussed the options around whether or not to jump through all the flaming hoops to get credentialed to accept everyone’s insurance. Working with insurance is such a common practice in today’s medical system that many of our patients just assumed we would. As of now, we have decided not to, and I wanted to share some insight into why.

PTs are set up for failure. 

Like many PT’s, I started my career working in high-volume clinics whose top priority was getting patients in and out the door – at the compromise of quality care. If you have been to a clinic before and felt as if your provider was absent or you were treated as if you were just a number on the list, you know what I am talking about.

At previous jobs, I was consistently treating 16-18 patients per day. That’s 18+ people per day that want and need something from you and you have to be on your game for. I don’t care how much you love your job or how altruistic your intentions are – that schedule is a fast track to burnout. Forget about creativity or the ability to critically assess what would be best for each patient – that goes out the door after the lunch hour and significantly downhill each day of the week approaching Friday. I was “sharing” each patient with an “aid” or “tech” who had “on the job training”. No matter how kind or hard working they were, at the end of the day my patients were there to see me, the doctor, not to kill 30-45 minutes of everyone’s time doing exercises with a “tech” so my company could bill more for the session. And I was running around in the chicken-with-my-head-cut-off fashion trying to give each of my patients as much of my time as possible while keeping up on documentation. No wonder work gave me anxiety. I started asking myself what other options were out there. This fast-food option of PT is not what I went to school to be a part of, but sadly is the norm across the country. 

Before I could even see a patient, many of them needed a referral per their insurance’s requirements in order to make an appointment. This means going to see their primary care provider and paying a copay and associated fees for 3 minutes of their time and being told to go see the PT. Insurance gets to collect a payout before the patient even receives help. 

For each patient that came in, I was expected to bill a certain number of “units” of time to their insurance. This generates an invoice that is sent to the insurance company after your session and is typically in the range of $200-$250 per visit (just to be clear, as a staff PT I didn’t even see a ¼ of that as income per hour, and was “treating” multiple people per hour). Even though you may have paid a copay already, the insurance company later determines what percentage of that total bill you owe based on deductibles and other factors, and then often hits you with a large bill 1-2 months after your visit. Not only do you get billed far more than the copay you thought was your only expense, but insurance also cuts the reimbursement to the provider by half or more. Ultimately, it’s a lose-lose for the patient and provider, but the insurance company always wins. 

What’s a PT to do?

So how do we break the wheel? I still don’t love the idea of being a business owner – would I rather show up to work, get paid, and have someone else manage all of this stress? Actually have paid vacation time and benefits? Absolutely. Sadly, insurance has essentially ruined “mainstream” physical therapy and it did not take long once I got into the “real world” after graduation to realize it. 

Fast forward a few years and a National Board Certification later, and here I am – a business owner. I’ve never wanted to be a business owner. After getting my doctorate, I can’t count how many times I was asked if I was going to open my own clinic, and the answer was always no. Sorry to all those people – I lied to you, but not intentionally! 

I am a rehab specialist. An expert in musculoskeletal conditions and movement. I did not put in the time and effort to become a doctor to have my practice dictated by greed and outdated insurance rules. I did not choose a career rooted in helping others to get 15 minutes with each client and then pass them off on a “tech” or hurry them out the door to meet an unrealistic quota or bill extra dollars. So here I am, a business owner – with my name on the door and everything. So that I can practice in the way that allows me to give my best and most greatly benefit my patients. Always 1-on-1 sessions, no fighting for referrals or authorization, no rushing patients out the door to squeeze more in. With the out of network model, we charge a flat rate, and you will never be hit by extra bills down the line, and always know what you are paying for. 

This is not to say that great PTs are not out there working in the mainstream system and still doing incredible things for their patients – they are! But many of them are not set up for success with the schedule and quotas they are trying to meet. This is a huge reason why you are seeing more and more independent, out of network practices like ours being established – and you shouldn’t hesitate to look towards them to provide you with the best PT experience possible. This is why Robin and I are choosing this route instead of taking everyone’s insurance, and we hope this provides some insight as to why. 

How can I still benefit from my insurance plan?

If you are trying to navigate how to get the most out of your insurance and still see a PT in a better setting, there are options! 

  • Use your HSA or FSA to pay for out of network costs
  • Call the number on the back of your insurance card – the majority of insurances will reimburse for out-of-network services when you provide a detailed billing summary, up to 100% of the cost! 
  • If you have a high deductible plan, you may be saving money anyway by choosing a pay-per-visit option if you will likely never reach your deductible 
  • Ask your provider about buying visit packages or payment plan options – most of them are willing to work with you to get the care you need

I hope this provides some insight into the structure we have chosen for our clinic. We truly believe it sets us up to provide all of our clients with the best experience, and for many people will ultimately save them money. We are always open to questions and helping navigate the confusing world of insurance, so don’t hesitate to reach out.