Why Private Pay Physical Therapy Benefits You

“I have insurance, why should I use private pay physical therapy?” That question comes up frequently when speaking with new clients and insurance is useful when it makes sense. Everyone has different circumstances and needs, so we wanted to provide a new perspective.

Custom Care Rehab is one of the many medical businesses that use a cash-based model, meaning we are a private pay physical therapy provider and will not be billing your insurance company for services provided. Services will be paid for upfront by the client. However, many times insurance companies provide out-of-network benefits that can reimburse a patient directly for any physical therapy services received (more about this later!) So, let’s discuss the benefits of using a private pay therapist using a few examples.

Being a cash-based business, this allows Custom Care Rehab to be a premium service. This allows us to focus on customer service, listen to your problems, and deliver results. You are not a patient that is just another number, you person who wants premium service and has your problem solved. There are many other premium services that we access on a daily basis. For example, do you have Amazon Prime? Why do you pay extra for Amazon Prime? You could purchase the same products through regular Amazon and just wait a few extra days for delivery compared to Prime. We purchase Prime because it’s a premium service that delivers our packages in two days along with having access to additional add-ons not included with normal Amazon orders. Most people would say they could never live without Prime. Amazon has provided a premium service worth the money.

Here a a few other examples of why private pay physical therapy benefits you:

Do you pay for a Costco or Sam’s Club membership on top of your grocery bill? You already have to pay for your groceries so why would you need to pay an additional fee? Because they have high-quality items for families and parties, quick check-out lines, and those awesome food samples! Again, it’s about the perks and we pay to have the premium perks.

What about a gym? Many times, we choose to go to the nicer fitness center that has more amenities, offers a more intimate service, and has a better atmosphere than a lower-ticketed, crowded gym. Again, we choose to pay more for this service even though there are cheaper options because we want a premium experience.

Think of physical therapy this way too.

If you pay cash, you are able to receive a premium service. Do you want the basic service or do you want the more intimate experience?

Insurance will pay for the basic service. Your health is one of the most important things we have in this life. You are worth the premium experience. With cash-based, we are able to take the time to learn about you and not rush you through an appointment only to get to the next patient. We want to provide a premium service with cash-based therapy by offering treatment in the comfort of your own home, with quick access, and by a highly trained specialty physical therapist.

“But I pay into my insurance every month, I want to use it.”

This is a fair point and insurance is useful for many things— doctors’ visits, trips to urgent care, wellness visits, unexpected broken bones, etc. However, you still wind up paying for costs outside your insurance like co-pays and surprise bills at the end of traditional physical therapy because the insurance didn’t cover certain codes or treatments which can be very frustrating! Cash PT is a flat fee, you know what you are paying with no surprise bills.

Let’s look at 2 scenarios.

Scenario 1: Say you awake the week of Christmas and you have vertigo when you go to get out of bed. You know you don’t feel right, you can function but feel nauseated and crummy, and you’re about to host the family Christmas dinner. You are thinking about going to physical therapy but in order to get referred, you need to see your physician first. Good luck getting into the physician the week of Christmas and then trying to get into a physical therapist who is likely taking vacation time the next couple of weeks.

For physician visits, say your co-pay is $40. You can get in to see your physician in 2 weeks. So, you turn to YouTube to try self-vertigo treatment and somehow make yourself worse! Christmas is miserable and you wind up in bed early every night.

Once you get into the doctor they give you Meclizine and an order for physical therapy. You call the therapist who can get you in the next week, but they are not certified in vestibular treatment and see a few dizzy patients a year. The Meclizine makes you sleepy and have to call a few days off of work, which is costing you a few hundred dollars at least.

3-4 weeks after the onset of vertigo, you go to physical therapy and your co-pay is $40 to be paid at each visit. They want to see you 1-2 times per week for at least 4-6 weeks because that’s what your insurance covers. You now have to drive to the clinic twice a week and pay $40 every time. You also have to schedule during times the therapy gym has openings so you need to get out of work early and find a sitter for the kids.

At the end of the 6 weeks, you still have dizziness because you did not go to a vestibular trained therapist. You are out hundreds of dollars in co-pay, money paid to the sitter, and time off work. The therapist sends you to an ENT for a full diagnostic workup which is going to cost you the price of your $1500 deductible and you have been suffering for months now.

Or you could just call Custom Care Rehab, have a certified vestibular physical therapist come to you when you get off work and while the kids are doing their homework you can get individualized treatment to treat your vertigo. For 2 sessions the cost is $325 vs the thousands you can spend over a 6 month period trying to find answers.

Scenario 2: Your 16-year-old daughter sustains her first concussion in a volleyball game. She is placed on limited school activity and no sports. She is starting to get behind in school work and is sad she cannot play with her team. She also has dizziness getting out of chairs, putting her shoes on, trouble reading, and daily headaches.

After 14 days the concussion doctor says she needs physical therapy for her persistent concussion symptoms, you pay the $40 co-pay.

You call the nearest concussion therapist and they start her on the typical Leddy protocol for concussion, which is gradual treadmill exercise and neck stretches. The plan of care is 2 x a week for 4 weeks with a co-pay of $40 a session, which is $320.

After 4 weeks the headaches have decreased to 2 days a week, but the dizziness is persistent. She was handed off to the school’s athletic trainer and started non-contact sports drills, but after another 3 weeks, nothing is better.

Your daughter is then sent for an MRI for persistent headaches with a $1500 deductible, which was negative. Then to a neuro-psychologist for a 3-hour test for post-concussive syndrome, which includes a $50 specialist co-pay.

The neuro-psychologist identifies that your daughter suffers from vestibular-ocular dysfunction and neck issues causing the headaches. The doctor recommends you see a vestibular therapist who also has experience with concussions and sends you to Custom Care Rehab.

After a thorough evaluation, your daughter is diagnosed with BPPV, benign paroxysmal positional vertigo, which is quite common in head injuries of any type. The dizziness is treated in the first evaluation and treatment session for $175. In the next session, she was found to have adhesions in the upper neck muscles. The neck was treated with massage techniques and given individualized exercises to resolve this; the cost of the follow-up was $150.

Dizziness is now gone and headaches only occur with poor posture in school. She was given the all-clear to start contact sports. She used Custom Care Rehab for 1 more session at $150 to update her postural strengthening program and manual techniques for treating tight neck muscles.

Traditional therapy pathway is lengthy and costly at $1910 vs a streamlined and individualized approach with Custom Care Rehab at $475.

See the difference?

A few other benefits:

We can address multiple issues you might be having at once, say for example you are having dizziness and start to have low back pain from the deconditioning since you’re not exercising any longer. Being a cash provider we can tackle both at once! Seeing a traditional physical therapist, you now have to see your physician again to get a referral for your low back pain.

You have skin in the game. Let’s be real, motivation can be tough and consistency is one of the hardest parts of making changes to your pain. You have to be consistent. It is easy to slack off if you know you aren’t paying for something or paying very little. There’s not much to lose. BUT if you are invested in something and you know the money is coming out of your pocket, you are much more inclined to actually do it. For example, let’s look at Planet Fitness- $10/month versus a premium gym that charges $200/month. If you slack off a month or three at planet fitness you are only losing $30 so it’s not very motivating to go. But if you are paying $200 you know that you are going to make it at least a few times per week so you get your money’s worth! Guess who makes more progress?

Long-term relationship with your physical therapist. Say you see Amy at Custom Care Rehab for your first vertigo episode. After one to two treatments you’re fixed and back to normal life, but 6 months later just before you’re headed on vacation and vertigo strikes again! Instead of having to go to your physician, you just text Amy. She comes to see you the next day, after doing some tests decides you don’t need an ER visit, and gives you some exercises to do for treatment. Then you can touch base as needed and you enjoy your vacation! How convenient!

What do you think? Any use for a premium concierge service like this?

**Out-of-network reimbursement. Custom Care Rehab provides patients with a “superbill” with all the information one would need to file a claim with an insurance company for out-of-network reimbursement. After an out-of-network deductible is met, the insurance company may in fact reimburse a patient’s claim directly.

*Custom Care Rehab cannot guarantee reimbursement for out-of-network claims, but the first step is to call your insurance company to discuss out-of-network benefits.

So in conclusion, the benefits of using private pay physical therapy are vast. If you value customer service, convenience, and results this company is the right fit for you. Custom Care rehab services Northeast Ohio and provides physical therapy for vertigo, dizziness, orthopedic injury, balance disorders, and more. For a full list of disorders we treat visit our page HERE.