Two simple reasons:
1. In order to spend more time one-on-one: provider and patient.
2. Because cutting out the middleman means decreased overhead and the ability to run a practice focused on ONE thing, the patient.
This takes us back to the simple life. Up until the 1950s, this was the traditional model. We want to care for patients the best way we know how. This involves spending time, face to face, listening, assessing, planning, and implementing based on your concerns and your goals. Providing this care as an in-network provider would be tricky. It would require much sacrifice, especially when it comes to time spent documenting, coding, and billing. These things do not impact your care directly and will not help you get better. These are the things that our healthcare system currently has wrong (at no fault of the providers, just a faulty system, unfortunately). In short, billing insurance requires staff to maintain the transactions with the middleman, it means decreased reimbursement (which varies depending on the insurance company), leading to the increased need to get patients in and out of the door, which requires hiring more staff to care for those patients and increased overhead… and, you get the picture.
Seeing a cash-based physical therapist, out-of-network can save you money and more importantly, your time! At Kaizen, that means we dedicate each entire one-hour session just on you to address your concerns and develop a customized treatment plan.
We want you to know that being an out-of-network provider is not a decision we came to quickly or easily. We debated the option to go in-network for the entire first year we were a distinguished company. However, in the end, we conclude it’s just not for us. Here’s another reason why. Insurance companies can be very restrictive. In-network PT is typically limited to “treating one body part,” while Kaizen is able to consider the patient as a whole person. We are not big on limitations – neither are you, which is why you’re here. In our experience, third-party payers pressure for immediate diagnoses, then insist on confining treatments, and simply put, interfere with the therapy we want to provide. This often hurts the patient’s progress and hinders our ability to reach his or her goals.
Out-of-pocket expenses over the course of physical therapy will often be less expensive for patients like you with a cash-based model than through a traditional physical therapy practice. Let’s do some simple math. While it’s hard to use exact figures because everyone’s insurance plans are different, the outcomes are typically the same.
If we take the “standard” protocol in an insurance-based model for a torn rotator cuff in a healthy individual (25-35), the patient will typically need 4-6 months of rehab requiring passive and active PT (~2x per week) according to the US National Library of Medicine. You may also have to worry about meeting your deductible and paying a co-pay at each visit. If you have a $50 copay for specialty care this might end up costing you up to $2,400 in copays or $3,000 if that’s your individual out-of-network deductible.
In our model we typically see the patient 1x a week and give them an extensive home program so he or she can begin working on the treatment plan at home. We also see our patient on average 6-10x during a plan of care and quickly go from rehabilitation to working on performance and prevention. Our ten-visit package is $1,800.
At the end of 6-months cash-based is often more affordable and less of a time investment. This also doesn’t account for the intangibles around enjoying a dynamic, individualized care plan and relationship built with your Kaizen PT.
We totally get it, we want to feel like we utilized the insurance plan we spend thousands of dollars on every year too. The thing is, health insurance was never intended to pay for our every health concern. It’s insurance, there if we need it in case of catastrophic events.
It’s worth mentioning here that the “cash-based model” is able to accept other forms of payment including credit/debit cards, checks, and even flexible spending or health savings account if your plan allows it. Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide reimbursement for specialty services received “out of network” (given your deductible has been met). We can help you with this process. Don’t be restricted by your current health insurance policy. Ask questions. Advocate for your healthcare.
Many people seeking cash-based care have high-deductible insurance plans. It makes sense to seek out cash-based providers when your deductible is $3,000 per person or $12,000 per family. You have more options and are able to choose a practitioner that fits your needs and values. Personalized care!
Have questions or want to learn more? Give us a call at 515-339-2906 or fill out a contact request here https://www.kaizenhealthandwellness.com/contactus.html
Dr. Ladd's views on performance improvement, injury prevention and sometimes other random thoughts.