Results-Driven Versus Insurance-Driven Care

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 our service is worth. We are considered "out-of-network" for a reason.

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 therapist (not an aide or assistant) 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 dig deeper to find the root cause and be a life-long learner in the pursuit of excellence to maximize the benefit for you.

As a courtesy, we provide a Superbill with all the information to submit your claim to insurance. This allows the visit to be applied to your deductible and the reimbursement comes directly to you. In today's world, many individuals and families have high deductible plans, often thousands of dollars. For example, the average family deductible in Ohio is $8,000 with individual deductibles averaging $3,738. This means you have to reach this amount before the insurance will reimburse you. If you have physical therapy at ABC Hospital, your out-of-pocket expense for ONE visit can be over $500 a visit. One local hospital charges $1,379 for the initial visit and treatment and the usual customary rate (UCR) is typically 50%, meaning your visit would cost you over $600 for ONE visit. You might wrack up a bill of several thousands of dollars and have no idea of the cost of the treatment until you receive a bill after several weeks to months. If you choose an out-of-network provider like Healthy Core, you would spend around $702 for FOUR VISITS with potentially a better ourcome. We believe in transparency and knowing up front the cost of treatment, rather than waiting several weeks to be shocked with a bill you cannot afford and a problem that might not have been solved. No wonder the physical therapy profession gets such a bad wrap!

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 a person was 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.

If you want results and to learn if our expertise is right for you, call our office for a FREE virtual consultation at 330-528-0034. We look forward to helping you achieve all that you can be, while spending less!

written by Janine Laughlin - August 2019, edited Janary 2026