How can cash-based physical therapy end up saving you money when the whole point of insurance is to cover your care? In order to answer that question, it’s important to understand what the parameters of insurance coverage are and how they affect the kind of physical therapy you get (and how long you get it). Don’t get us wrong: insurance can be a solid option in a few different scenarios, and it’s worth talking through your specific circumstances with your doctor as you evaluate your options. That said, you do have options beyond insurance-centric care, and making the best decision for your long-term health means being aware of what those options are. Today, we’re covering what the general insurance stance is when it comes to physical therapy, what that means for you long-term, and how you can make the best choices for your physical and financial health both now and in the future. Let’s get started.
Insurance and Physical Therapy
Generally speaking, physical therapy is covered by insurance in circumstances where the care is considered “medically necessary.” In those cases, insurance usually places a cap on the amount of time for which patients can receive care. More often than not, there is also a co-pay involved (even for in-network doctors). In the most straightforward terms, this can mean a few things for patients:
- The type of physical therapy care that’s covered by insurance is usually reactive – that is, as a direct result of an accident or illness (more on this later).
- There are time constraints associated with your care. After a certain amount of sessions, insurance coverage will no longer apply.
- You may have to choose from a predetermined list of in-network physical therapists.
- You will still have out-of-pocket costs in the form of a co-pay.
This is pretty standard information; any insurance holder is likely to be able to predict it and plan accordingly. However, when we look at these guidelines in practice, what does it mean for your quality of care and your long-term wellness?
What’s Necessary and What’s “Not”
First and foremost, let’s take a closer look at what insurance companies deem to be “medically necessary” physical therapy. Medically necessary care is defined by Healthcare.gov as “Health care services” that are necessary in order to “diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.” In other words: in order for your insurance to cover physical therapy, it must be able to prove that the treatment is directly linked to an illness, injury, or disease. This means that insured physical therapy is primarily reactive: it seeks to treat a specific injury or pain that’s happened as a result of an accident or disease.
This emphasis on reactive care doesn’t seem like that big of a deal, but it’s important to understand that reactive physical therapy only scratches the surface of the life-changing care that’s available to patients. Preventive physical therapy is one of the most useful forms of physical therapy out there: it serves to improve mobility, strengthen the body, boost mindfulness, and stave off potentially devastating illnesses or conditions down the line, like osteoporosis, arthritis, and heart disease. It also helps patients bounce back faster from injuries caused slips, falls, and collisions.
Less is More
Here’s how insurance limitations trickle down to physical therapy: insurance companies set guidelines about the types of treatment they are willing to cover. Then, the insurance company’s in-network physicians and doctors of physical therapy are updated about these guidelines (and expected to oversee their care accordingly in order to make sure patients are covered). For the purpose of physical therapy, that means an emphasis on specific injuries, not on how these injuries are integrated into whole-body movement and holistic health. For patients, this can mean a lot of things: it means more sessions may be required in order to improve overall strength and mobility, since injuries are isolated and treated more often than they are integrated into whole-body training.
Because insurance companies usually place limitations on the number of sessions that patients receive, it also means that patients are very frequently discharged from their physical therapy treatment before returning to 100% of the mobility and strength they had before their injury. Holistic, long-term physical therapy presents a different approach: by offering customized care that is completely subject to change depending on a patient’s evolving needs, cash-based physical therapy doesn’t limit treatment. As a result, fewer sessions may be required on a weekly basis to see the same results that insurance-based care would provide.
Looking Long-term
Because insurance typically doesn’t cover preventive physical therapy, and is unlikely to cover physical therapy for old aches and pains, it’s important to be realistic about the real costs associated with going through insurance. Insurance-based care is specific: the focus is less on holistic mobility and more on treating a particular injury or pain. This means that the care isn’t geared toward boosting your overall strength and avoiding devastating injuries in future slips, falls, and accidents. It’s also time-constrained: if you have a persisting ache or pain once your insurance coverage period for physical therapy is over, you’ll have to shell out money out-of-pocket to continue your care.
All in all, there’s nothing wrong with reactive physical therapy – but there’s no overstating the benefits of preventive physical therapy. By improving strength and flexibility, diversifying mobility, and reducing the risk of injury down the line, preventive physical therapy reduces the risk of serious injury and many illnesses in the future. Insurance-based physical therapy can be a great option in the short-term. However, if you’re looking to boost long-term wellness and save plenty of time, money, and resources in physical therapy or medical bills down the line, it’s highly advisable to consider cash-based preventive physical therapy now (note: cash-based physical therapy refers to direct payment, not just cash. At Purpose, for example, patients are welcome to make their payments via debit card, credit card, and even FSA and HSA accounts!).
Cash-based physical therapy can be life-changing, and it’s proof that you have more options for physical care available to you than you think. To explore this option further, don’t hesitate to reach out to us. Claim our exclusive new patient offer by clicking here.