Health insurance is a requirement as a US citizen, but what does it actually cover? Every plan is so different and things change so often – how can anyone actually know what their benefits are? As I tell all of my patients – get online or call your insurance carrier so that you understand your specific plan, the amount of money that you’ll be responsible for with each visit or procedure, and how many visits a plan covers. The other thing to make sure you are aware of is whether or not there is a management company for your plan and what those parameters are for specific treatments. One of the worst things that we deal with in physical therapy is that the insurance company covers 20 visits of physical therapy per year, but they actually utilize a management company that will only give the patient a set number of visits (usually 6). After the 6 authorized visits are used, the PT has to appeal this with the insurance company, which requires a lot of paperwork, and usually they are only given a maximum of 3-4 more visits. What if you need all 20? What if you had surgery and need a longer rehabilitation, or what if you have a set-back and need more visits? Too bad…I’ve tried to appeal these decisions many times and after a lot of paperwork, phone calls and time, the most visits we ever seem to get are 11-12 even though the person is allowed 20 visits per year!
Does this give you any more insight to why I do not accept insurance?
The other thing that is becoming much more commonplace is the high-deductible plan, also known as catastrophic coverage. For many people the deductible is anywhere from $5,000-$10,000. So if you were to be in a “catastrophic” accident, which normally means that you are required to have surgery or be hospitalized, this would add up to $5,000 very quickly and after your deductible is met you would only be required to pay 20-30% of the claims until you meet your out-of-pocket maximum. That being said, most people are not anticipating a catastrophic incident and hopefully do not have medical costs that get anywhere close to $5,000-$10,000. This means that for any general medical care, the patient will pretty much be paying out-of-pocket until they meet that deductible amount. So for in-network physical therapy visits, you might pay anywhere from $80-150 for about 15-30 minutes with the PT (who is most likely supervising some other patients at the same time) and then possibly some other exercises or modalities. So unless you are being seen for post-operative rehabilitation and need to see a PT 2-3x/week, why not see a PT that gives you their full attention for 60 minutes, listens to you and treats you with specialized hands-on techniques and exercises that are completely customized to YOU! Most patients in this environment see results much quicker, as they are getting much more specialized treatment for a longer period of time. Many hands-on techniques can be done quickly, but some of the the more specialized techniques that can create longer lasting results take much more time because it requires working into deeper muscle and fascia to produce more permanent results.
If you have been suffering with pain, tightness or decreased mobility for a longer period of time and nothing else seems to be helping, this is likely the treatment that you need! I have had incredible results with people that have previously seen a lot of other practitioners without great improvement. This is usually because I am able to spend much more time with my patients now that I am out of the insurance game. Getting people better in less time is my specialty, and if I am not seeing the progress that I am anticipating within about 4 visits, I have a large network of providers that I will refer the patient to in order to get the patient the optimal care that they need.
I am a physical therapist, so this is really the only healthcare field that I feel comfortable giving information about, but many other health professions are having the same exact issues. If you want more time with your healthcare provider, it might just be time to look out-of-network or towards something called “concierge medicine.” I feel that it is worth it, as we have time to listen and get to the root of the problem rather than just using band-aids (medications, injections, non-necessary surgeries).
If you are interested in improving your quality of life, reducing and eliminating pain and improving mobility, call or email Solstice Physical Therapy for more information. (720) 369-7738 or info@SolsticeHealthcareResources.com.