HEALTH INSURANCE vs DIRECT CARE?

Many people don't realize that using their "Health Insurance" may not be the most cost-effective thing to do.  Even though I accept most major insurances, many times, you the patient might actually end up paying MUCH MORE in the long run for less-effective, lower-quality Physical Therapy compared to if you had opted for the Direct Care route.


So what is Direct Care?


Direct Care is a relationship between you the patient, and me the Physical Therapist.  NO MIDDLE MAN (Health Insurance Company, Adjusters, Documentation System Administrators, Billing Company) OR NONSENSE (caused by the Health Insurance Company, Adjusters, Documentation System Administrators, and Billing Company).  In other words, you pay a significantly reduced FLAT RATE per Physical Therapy visit without limitations on treatment provided for at least an hour of one-on-one, hands-on treatment by your Doctor of Physical Therapy (NOT a Physical Therapy Assistant).  This FLAT RATE is typically in the area of 60-75% lower than what your cost will be when you go the "Health Insurance" route AND you will receive a superior level of specialized care without limitations imposed on the Physical Therapist by the "Health Insurance" Company.


What limitations on care do you ask?


"Health Insurance" Companies have developed a very flawed system of determining what services THEY feel that YOU need, to minimize what they have to pay.  They dictate nearly every aspect of care.  Most of the time they will only pay for 30 to 40 minutes of treatment by limiting the reimbursement level (what are we going to accomplish in 30 minutes?  NOTHING).  I usually see patients for 50 to 60 minutes ANYWAY, even though I'm not being paid the same for it.  They also dictate the types of treatment performed, which in many cases aren't the most effective treatments, and how often they can be provided.  SHOULDN'T THIS BE THE DECISION OF YOUR PHYSICAL THERAPIST?  IT'S ALL ABOUT MONEY FOLKS!


How can this be?


This is a reality for many reasons because of the structure of many commercially available health plans, policy and red tape of the plan, and the fact that Physical Therapy is not an "expensive" service compared to many other services like, say, a shoulder surgery that could easily cost $15,000 or a back surgery that could cost $50,000 (which, by the way, we now know that many orthopedic surgeries are actually quite unnecessary and many times cause bigger problems than they solve!).  These "expensive" services easily eat up your deductible, unlike Physical Therapy, and you end up falling for the illusion that your health plan covers more than it actually does.


Think about everything you pay each month for your "Health Insurance" plan.  Hundreds, if not, THOUSANDS of dollars every single month on your monthly premium, your copay (20-40 dollars per visit), your coinsurance (20-40% of charges for services provided that are "covered"), and last but not least your deductible (for many people is astronomical in the neighborhood of $5,000 to $10,000 per year).  The elephant in the room here is your DEDUCTIBLE.  All your "Health Insurance" Company is going to do is apply all of the charges submitted for your Physical Therapy treatment to your deductible and make you responsible for EVERYTHING!


​Now factor in the other side of the equation.  In order for me to even be able to accept your insurance and file claims to get paid, I have to use an EXPENSIVE cloud-based Documentation System that covers the ridiculous documentation requirements of all of the health plans out there (which by the way is A LOT and every single one of them is different).  Then, I have to use an EXPENSIVE Billing Company that interfaces with the expensive Documentation System because the process of submitting and monitoring claims is so complex and difficult that it simply cannot be done by anything less than a TEAM of billing professionals to handle.


What does this all mean?


WHEN YOU USE YOUR "HEALTH INSURANCE", I HAVE TO SIGNIFICANTLY RAISE MY RATES TO COVER MY COSTS SO THAT I CAN KEEP MY DOORS OPEN.  IF YOU HAVE A HIGH DEDUCTIBLE HEALTH PLAN, YOUR "HEALTH INSURANCE" IS GOING TO MAKE YOU RESPONSIBLE FOR ALL OF THE CHARGES WHICH INCLUDES THE HIGHER RATES.  I HAVE SEEN, IN MANY CASES, PATIENTS PAYING BETWEEN $175 TO $200 PER VISIT (SOMETIMES HIGHER) FOR SHORTER-DURATION, LOWER-QUALITY TREATMENT WHICH ULTIMATELY MEANS YOU WON'T GET BETTER AND YOU WILL BE IN THERAPY LONGER.


MY DIRECT CARE FLAT-FEE IS $125 PER VISIT PERIOD!  YOU WILL RECEIVE HIGH QUALITY, SPECIALIZED, ONE-ON-ONE, HANDS-ON CARE PERIOD WITHOUT A "HEALTH INSURANCE" COMPANY DICTATING YOUR CARE!  THIS MEANS YOU GET BETTER, FASTER, IN FEWER VISITS, WHICH SAVES YOU EVEN MORE TIME AND MONEY!


PLEASE DON'T HESITATE TO CONTACT US WITH ANY QUESTIONS OR CONCERNS YOU MAY HAVE ABOUT YOUR CONDITION AND TO FIND OUT HOW WE CAN HELP YOU REGAIN YOUR LIFE.