Hot Take: Why Insurance-Backed Physical Therapy Falls Short

By: Kelsie Mazur, DPT

This week’s blog post is so SO IMPORTANT and I am going to break down why. Here at Wattage, we do not bill insurance companies for physical therapy. Wattage is not the only physical therapy provider that chooses not to accept insurance as a source of payment for your treatment; multiple private physical therapy clinics have also opted out of doing so. This topic can be confusing so I tried my best to break it down for you. If this blog feels too lengthy for you, I encourage you to stick with it, as the information is extremely valuable. 

You deserve better than what your insurance allows!

Here at Wattage, we choose to use what's called a “cash-based payment model” for our physical therapy services. We do this for 2 main reasons: 1) Me (Kelsie) and 2. Because you deserve better than what your insurance allows. I did not go to school to become a Doctor in physical therapy and an anatomy expert for an insurance company to tell me how long I can treat a patient, and what I can and cannot do with them. That’s right, insurance companies dictate the course of your care (within physical therapy), basically having control over the therapist. In simpler terms: someone that works at Blue Cross, United Healthcare, Medicare, etc. most likely without holding a medical degree, sits at a desk and tells the physical therapist what they are allowed to “Bill for” and what the insurance will “reimburse”. This process can take days, weeks or even months to correspond with. This wastes valuable time, sometimes causing the patient to sit with their pain or disability. More importantly, insurance companies are concerned with both saving and making the most money, leaving them to pick and choose what services they are willing to cover regardless of the outcome of care for the patient. So what does this mean for the person with a herniated disc unable to work, or a person with foot pain who had to cancel marathon training? Bluntly, it means that they’re getting crappy care over the course of weeks/months because a corporation said so.

Here is an example show casing when an insurance company has too much control over patient’s care: While working with a previous employer, I had a patient who’s requested appointment was denied by insurance. This patient then had to reschedule three more times, waiting on “authorization” from a primary care physician. What is wrong with this picture? That’s a month of time wasted that she will never get back; it prevented her from getting the help she needed to ultimately get her back to doing what she loves.

 You might be thinking: But paying $200+ dollars out of pocket for Physical therapy sounds crazy expensive!

While insurance-based physical therapy often involves copayments, deductibles, and varying reimbursement rates; cash-based physical therapy operates on transparent pricing. Meaning, here at Wattage, you usually make 1 payment depending on the package you purchase or 1-off payments from visit to visit. Contrary to popular belief, you might actually save money! I don’t know about you, but personally I have a $6,000 deductible. Meaning, if I choose to use insurance for my own personal physical therapy needs, I am GUARANTEED a co-pay which is most likely $40-50 dollars each visit. The worst part of all of this, I am also GUARANTEED a bill of an unknown amount to make its way through the mail. So if I was scheduled 2-3x per week, which is usually the case in the traditional therapy model, that's roughly ($120-150) a week with sub-par care. The cash-based model Wattage offers is a straightforward approach that allows you to clearly understand the costs associated with each session or package of services upfront.

Lastly, I need to stress that at Wattage, as well as other cash-based private clinics, you actually get to see your physical therapist. This sounds like common sense, but is often not the case at more traditional facilities. Traditional model physical therapy clinics (that utilize insurance) will often use rehab technicians (usually high school or college students), physical therapy students, or physical therapy assistants to fill the service in order to get more patients in the door. Physical Therapy at Wattage is 100% one-on-one time with your trained Doctor of Physical Therapy, Me! With that, I am seeing patients anywhere from 60-90 minutes at a time. This longer one-on-one time with your therapist enables more in-depth assessment, personalized attention, and comprehensive treatment. The best part about this: I do not have to see patients as frequently as a traditional PT model would. This will play a huge role for those patients that have a high co-pay or deductible. Most of my patients actually only come in 1x per week, and are provided tools to use on their own. 

Does Wattage take out-of-network benefits?

Just because we may not be in-network with your insurance, does not mean you cannot utilize out-of-network benefits you may have that could get you reimbursed. We can provide you with a “superbill” at your request that you can submit and get reimbursed by your insurance company. If you’re curious about this process, feel free to chat with me in person or email me kelsie@wattagept.com with any questions you may have. 

My expectation is for my patients to get better faster at Wattage.

Everyone here at Wattage (trainers included) are very serious about quality over quantity. Trainers are most often included on the plan of care for rehab, and willing to optimize/customize workouts catered to the rehab plan to not only save you money, but get you back to doing the things you love. 

Have other questions or need assistance with a current injury? Reach out to us and learn how we may be able to help! Don’t forget to follow us on instagram @wattagept for cool tips and tricks to optimize your ability to stay pain free and in the gym