Most of us have (or have had) a health insurance plan. These plans can be life savers when it comes down to unexpected medical costs, like major surgeries and hospital stays. An average inpatient hospital stay in the United States cost $11,700 in 2016.
What most people don't realize is that when it comes down to the more minimal medical stuff, cash-based or out of network providers can actually be cheaper. Of course, this isn't true for everyone, but folks with high deductible insurance plans could especially benefit from out of network services.
Here's a look at how traditional insurance billing goes (at least in terms of physical therapy)...
You're seen for your very first visit (the initial evaluation). Based on things like your diagnosis, medical history and other contributing factors the therapist will categorize you into either a low, moderate or high complexity evaluation. Typically, the higher the complexity (or the longer the evaluation takes) the more the assessment costs. The screenshot below was taken directly off of a local hospital's charge master as an example.
Depending on what your physical therapist recommends for treatment the insurance company will approve a certain number of visits for a certain duration of time (ex. 6 visits over a period of 8 weeks).
You will work with your physical therapist each visit and be billed for what was performed during that visit. The length of time the treatment takes dictates what is billed. See the below snip of the cost of 15 minutes of manual therapy (soft-tissue massage, joint mobilization) if you have Blue Cross PPO insurance at a local clinic.
To make things simple, let's assume you were a low complexity evaluation (average price $146.18) and were seen for a total of 6 treatment visits. These treatment visits were 30 minutes long and you were billed for manual therapy for each of them ($160.50 per visit if you had BlueCross PPO). Grand total = $1109.18
If you haven't met your health insurance deductible yet for the year, then you're probably looking at paying this amount out of pocket. Yikes!
If you happen to need more therapy than what the insurance company initially approves a re-evaluation will be completed and sent in to the health insurance provider in an attempt to get more visits authorized. The documentation sent in has to prove that you are making progress toward your goals in order for more visits to be approved. Once you stop making progress you will likely no longer be able to use your insurance plan to cover visits.
Using the same scenario above, let's break down the cost of cash-based physical therapy. If you were seen for the initial evaluation: $120 (no matter the complexity). Then, you choose to be seen for 6, 30 minute treatments: $60 each. Grand total = $480. That's a savings of $629.18!
Better yet, there's no waiting for your insurance company to approve visits. You can be seen as often as you like and for as long as you find it beneficial. Ready to get started? Head back to our main page and click on the book now tab to set up your first visit!