The Insurance Dilemma


The first question we often get when someone is seeking physical therapy is "do you take my insurance?" The answer is yes, but we do not have a contract with the insurance company that forces us to agree to accept what they think the service is worth. We are considered "out-of-network" for a reason.

New research suggests private pay physical therapy is more cost-effective and provides greater outcomes! We have known this for years and it was a contributing factor when we discontinued our one-way contract with insurances over five years ago. WHY? Because we value your time and attention to detail with one-on-one care that insurance companies do not value. It is also why we have advanced training and expertise to provide a higher level of service that is difficult to find anywhere else.

Have you ever been to physical therapy at a high volume clinic? Did you notice your therapist's time was divided between multiple people while you were receiving care? When I worked in outpatient physical therapy years ago, I often treated 28 patients in a day. To "buy" time, we used hot packs, ice packs and electrical stimulation or placed patients on exercise equipment while we bounced between patients. This concept is fine if you are seeking help for a sports injury or postoperative condition that requires a protocol such as after knee surgery. It doesn't work so well if you have chronic pain or dysfunction or an acute condition that needs attention to maximize healing potential. When you receive treatment at Healthy Core, you have undivided attention from your physical therapist and you see the same person every time! Our advanced training and experience also means fewer visits in less time with better outcomes! We also have higher job satisfaction, knowing that we gave our all and patients get the outcome they are looking for. This means your therapist will be a life-long learner and pursue excellence to maximize the benefit for you.

As a courtesy, we have systems in place to electronically submit your physical therapy claim to insurance. This allows the visit to be applied to your deductible and the reimbursement comes directly to you, without any work on your part. In today's world, many individuals and families have high deductible plans, often thousands of dollars. For example, if you have a $5,000 deductible and you have physical therapy at ABC Hospital, your out-of-pocket expense can be over $500 a visit. You have no idea of the cost of the treatment until you receive a bill after several visits. We believe in transparency and knowing up front the cost of treatment, rather than waiting several weeks to be shocked with a bill for thousands of dollars.

Do you know that the goal of the insurance company is to make a large profit? Do you think they sit around at board meetings thinking of ways to better serve you and save you money? Of course not; that's our job. When we have meetings, we discuss ways to improve our delivery of care and have ongoing advanced training to get you better quicker. The problem with health care is that hospitals and insurance companies have agreements not to better your health, but to make a larger profit. Providers at large hospitals are often not allowed to refer patients outside the network in order to keep the profits in-house. This gives you no choice but to see an in-network provider who may not be the best match to deliver the outcome you expect or deserve.

As a former hospital employee, I can tell you that mediocrity is the norm. There is no incentive to work harder or to be an expert. If you do, you might make the other therapists look bad (this happened to me at two different hospitals I worked at). I was bullied to "fit in" and not ruffle any feathers and to stick to treating one body part (as if people were not a whole person). I felt the life drain out of me and I brought that stress home to my family. This was one of the reasons I left the hospital system in search of a more optimal way to deliver care and address the entire person. After all, everything in the body is connected. It is not the therapist's fault or the doctor's fault, but the system that does not allow them to do all that they can do for a patient. The depression and suicide rate is at an all time high for healthcare providers who went into a profession to help people. However, they are being told how to deliver care from someone who doesn't have a medical degree, but an accounting or finance degree, or from a third party insurance company that sets the dollar value on the service. Because of the dwindling reimbursement from the insurance company, providers have high quotas of how many patients to see in a day, or how many units to bill. They are stuck behind computers justifying why the insurance should pay for the service and documenting inside an electronic health record that was supposed to improve efficiency. They no longer touch patients or have time to promote a healing environment. Healthcare has become big business unfortunately. As a small business, we recognize this. We also recognize that we cannot help everyone. We have learned that when you try to help everyone, you help no one! The individuals that seek help from our clinic share our values of time and excellence, without all the obstacles in the way of getting the best care. We strive to exceed all expectations.

To find out if our expertise is right for you, call our office for a FREE consultation at 330-528-0034. We look forward to helping you achieve all that you can be!

Featured Posts
Follow Us Click Below!
  • Facebook Basic Square
  • Instagram Social Icon
  • LinkedIn Social Icon
  • YouTube Social  Icon
Recent Posts
Archive
Search By Tags