Does it really matter whether you choose cash-based physical therapy (“out-of-network”) vs. services through your insurance (“in-network”)? Yes, it does! Both of these options have their own positives and negatives, and in order to get the most out of your care, time, and finances, you should explore these options thoroughly.
There are many misconceptions about both cash-based physical therapy and insured options, so it’s very important to do your research to determine which may best fit your individual needs.
The aim of this blog is to help you better understand the difference in the quality of care, costs, and overall experience between cash-based practices and insured physical therapy.
Every person’s health and financial needs differ, but with the information presented below, you’ll have a better understanding of how each form of care works and how to decide which is a more suitable option for your needs.
Insurance vs. Cash-Based Practices: The Difference
What is the difference between seeing a provider who is cash-based vs a provider who accepts payment through insurance? Let’s do a short and simple comparison that will help you better understand your options.
- Cash-based (out-of-network) physical therapy provider:
- Requires full payment at the time of service
- Despite the term “cash-based,” they accept many different forms of payment
- Pricing depends on the provider and services needed
- Pricing is often fully transparent and priced per session
- Physical therapy provider that accepts insurance (in-network):
- Must be part of your specific insurance’s network
- Pricing depends on the rate the provider negotiates with your insurance plan
- Pricing is often highly variable due to changing treatment codes from session to session
- Despite being in-network, not all services may be covered by insurance
Let’s further explore the differences between these two types of healthcare below!
Cash-Based Physical Therapy
Cash-based physical therapy, as outlined above, refers to providers who are not in an insurance network, also known as an “out-of-network” provider.
These providers can range widely in terms of their services and specializations, but can often be highly skilled and may have the ability to provide longer, more focused one-on-one sessions with their patients.
It’s important to thoroughly research any physical therapy clinic you may choose to see beforehand, as you’ll want to compare prices to other clinics in the area and make sure they are familiar with your specific condition or needs.
Dr. Laura Meihofer works in a cash-based clinic, and is therefore an out-of-network provider!
Advantages of Cash-Based Practices
Cash-based (out-of-network) providers can be extremely suitable for a variety of people, especially those looking for specialized care. This type of provider can have many benefits for patients, many of which are overlooked when looking for healthcare solutions.
This is because cash-based providers are not limited by insurance restrictions and form their own rates and availability; therefore, your experience can vary from provider to provider.
However, in general, seeing a cash-based provider can create a more personalized, accessible, transparent, and often affordable care experience.
You can read more about this care experience below!
Quality of Care
Working in a cash-based practice allows Dr. Meihofer to devote more time to patient care and continuing education. She is able to schedule her patients with more ease, and not have her patients wait an extremely long time for an appointment.
The length of your treatment or appointments will be determined by your health needs and goals, rather than a number decided by an insurance company.
In addition to this convenience, she is able to happily provide a holistic, comprehensive care approach that utilizes evidence-based techniques. She is able to work with her patients and their personal needs without restriction.
With less restriction, Dr. Meihofer is able to integrate a preventative approach to her care. The goal is to not just help heal current conditions, but prevent future issues or relapse, too. This is one service that providers who are tied down by insurance companies may not be able to provide as often.
Furthermore, cash-based physical therapy providers are able to truly connect with patients.
When patients with long-term (chronic) conditions need care, it can be very beneficial to continue working with a provider whom they’ve got an established relationship with. Familiarity and comfort can go a long way for a patient’s care experience!
By avoiding the stress and burnout that comes with working through an insurance company, cash-based physical therapy providers are able to provide their services to the best of their abilities; meaning they can provide care that is fully attentive, holistic, and sincere.
Similarly, patients can receive proper care without the stresses of insurance restrictions.
However, we know that there are a lot of misconceptions about the cost of cash-based (out-of-network) physical therapy, so we’ll discuss that next.
The Cost of Cash-Based Practices
In terms of affordability, you may be surprised to find that the cost of care with a cash-based provider can be very similar or even more affordable than what you’d pay through your insurance.
Many sources state that out-of-network services will always be more expensive, which is simply untrue! There are many ways that out-of-network services can be very affordable…
Firstly, just because a provider is out-of-network does not necessarily mean that your insurance cannot cover your care. Many individuals can submit a superbill (an itemized receipt of completed cash-based services) to their insurance for out-of-network coverage!
This means (depending on your individual insurance benefits) that you may be eligible for full or partial coverage even for out-of-network services. Always be sure to thoroughly research your insurance plan to see if this is a possibility!
Additionally, many cash-based physical therapy providers offer discounted service packages to make your visits more accessible. This means by purchasing a set number of sessions, you can save on your total cost of care.
There are also many cash-based providers that accept HSA and FSA funds (including Dr. Laura Meihofer). You can read more about these types of healthcare funds by viewing the guide: “Does My Insurance Cover My Care?” found on the Helpful Documents page.
Disadvantages of Cash-Based Practices
In some cases, there may be some disadvantages to utilizing cash-based providers. As mentioned already, this may vary depending on your location and care needs. To receive services from cash-based providers, you may come across the following challenges:
- Depending on your location, you may need to travel for specialized services that best fit your needs (keep an eye out for telehealth services, too).
- You’ll have to understand a different billing or payment method, such as superbills. You can read about superbills on the Helpful Documents page.
- You will not be able to use your insurance’s provider locator and will need to research providers on your own. There are some directories designed for this:
Health Insurance and Its Misconceptions
As mentioned before, there is a big misconception that cash-based physical therapy services are always significantly more expensive than insured care. In reality, there are many things that may make in-network care more expensive; often unexpectedly.
Firstly, it’s important to know that health insurance is highly variable. The amount you will pay for your care depends on your personal health insurance plan, which varies greatly from person to person.
Therefore, if you do have insurance, you will want to thoroughly research the details of what your insurance pays. Not only so that you can understand your options, but also so that you are not blindsided by unexpected, uncovered costs (regardless of whether you choose in-network or out-of-network care).
Another important thing to know is that even if the services you need are covered by your insurance in some way, that doesn’t necessarily make them cheaper.
This is due to many different factors, such as:
- Very high deductibles
- Copayments
- Coinsurance
- High out-of-pocket maximums
- Uncovered expenses
All of these factors can affect how much you end up paying for care. Understanding these factors in regards to your specific insurance plan is essential for estimating what your cost of care could look like; whether you choose in-network or out-of-network services.
That’s right—you’ll want to research both in-network and out-of-network coverage for your plan. Some types of insurance may provide out-of-network benefits; meaning you could be eligible for reimbursement, which we mentioned earlier.
This means you can see a cash-based physical therapy provider, pay out-of-pocket for their services, and then submit a copy of what you paid to your insurance. They will then review the services paid and determine whether or not to send you a reimbursement check.
Truthfully, this can be a bit of a battle between you and your insurance, so be sure to strongly advocate for the benefits specified in your plan, and be sure to check beforehand exactly what your plan includes.
As previously mentioned, each plan differs. Physical therapy may be covered, partially covered, or not covered at all (both in-network and out-of-network). Therefore, it’s very important to consider all your options, and compare the costs you would pay with your insurance vs. what you might pay with cash-based physical therapy.
About In-Network Care
Although health insurance can be confusing and may not cover all physical therapy services, it can still offer benefits for many. The point of this blog isn’t to discourage you from using insurance based providers, but rather encourage you to do thorough research and explore all the options available to you.
In-network providers may be a good opinion in many cases, such as for individuals who:
- Have good coverage plans
- Are high risk and need frequent care
- Do not have suitable cash-based options nearby
Obviously, health insurance plans are often necessary to cover specific types of preventative care services. This can include vaccinations, colonoscopies, mammograms, flu shots, and annual check-ups.
This, however, does not always include specialty services such as physical therapy. It greatly depends on your individual plan and what your insurance considers an essential benefit or preventative care.
This is why doing research on your unique insurance benefits and the cash-based options around you is so important. Insurance coverage can be confusing and highly variable. By simply ruling out out-of-network providers, you could be missing out on care that is more suited to your needs, less of a hassle, and still very affordable.
Another aspect of in-network care that many do not consider is the actual care experience itself, which we’ll look at below.
Disadvantages of In-Network Care: The Experience
Although in-network care can be a suitable option for many people, there are definitely some downsides that must be addressed.
Firstly, insurance coverage is a battle. It’s no secret that the American healthcare system is confusing and complicated.
There’s the possibility of denied claims, network issues, authorization problems, confusing terms involving coverage, high premium rates, high deductibles, high out-of-pocket maximums, and so on.
Even worse, the quality of care may not be guaranteed even with your services covered.
The unfortunate reality is that even if your insurance plan covers physical therapy or even out-of-network services, you may still experience other challenges. When dealing with insurance companies for health care, many patients experience barriers to receiving the care they need, which may include one or multiple of the following challenges:
- Limited number of appointments
- Very long waiting times for appointments
- No access to their providers between appointments
- Appointments that are short or rushed
- Low variety of specialty preventative health services available
- Less providers to choose from
- Covered providers are far / require travel for visits (such as for those who live in rural areas)
- Coverage is too strict or not transparent enough
- Slow progress on health needs
- Health-related needs are not properly met
The last bullet point of that list is extremely important. Although insurance limits the number of appointments a patient may have and what providers they can see, patients are actually not the only ones directly restricted by insurance.
Providers also experience their share of struggles to accept payment via insurance, which in turn affects the quality of care they can offer to patients.
Providers who accept insurance have to dedicate time to complex administration tasks, such as gaining permission to treat patients (pre-authorizations), filing paperwork, using difficult billing procedures, dealing with payment delays, and other requirements involved with insurance.
In some cases, private practice providers may even raise their rates simply to offset the insurance costs incurred to their business.
To put it simply, providers should be able to focus on providing exceptional care to their patients—not fighting paperwork, restrictions, and administrative tasks.
Unfortunately, many patients find themselves seeking cash-based physical therapy options after their insured option did not meet care expectations. They may not have seen any improvements in their health, or perhaps they didn’t feel as though they were receiving a well-rounded plan of care.
In worst case scenarios, patients may feel that they just aren’t being heard while receiving their services. Obviously this problem isn’t necessarily exclusive to in-network providers, but with the restrictions caused by insurance companies, it can be a common experience.
In other cases, being forced to see an in-network provider because of insurance coverage also means that your provider may not be suitable for your unique needs.
If you are someone who needs an inclusive provider, such as someone who is experienced with taking LGBTQIA+ patients, you may experience more difficulty finding care through your insurance’s directory.
Even after the creation of the Affordable Care Act, many members of the LGBTQIA+ community still find themselves experiencing discrimination and other concerns with healthcare—such as costs, quality of care, and delays.
As you can see, the road to care is not so easy. While financial factors can be a major priority for many, the true goal of seeking health care is to actually get better. So while doing all this research and making phone calls to your insurance or to clinics can seem like a pain, it can be an essential step towards getting the quality of care you need.
Understand Your Options and Personal Needs
Now that you have more information about the two different options for physical therapy care, it’s time to consider your own needs. Are you looking for highly specialized or long-term care? Do you need more appointment availability or providers to choose from? What are your must-haves when receiving care?
Be sure to jot down what you’re looking for in terms of care so that you can easily refer to and prioritize them.
As said many times before, you’ll want to investigate your current insurance policy (if you have one) and see how it compares to any out-of-network options you may be considering. Does your policy cover your needs? What is your deductible or co-pay? Are there any out-of-network benefits? What would you be paying if you chose cash-based physical therapy instead?
Take all of these factors into account while choosing a path to take. Your health is of utmost importance, and should never be taken lightly. You deserve comprehensive, high-quality care that meets all your needs! Never stop advocating for yourself.
If you’d like to get started with an experienced provider who truly cares, make an appointment with Dr. Meihofer!
Or if you need more information, check out these helpful documents and the FAQ page.
