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Why Choose Out-of-Network Physical Therapy?

Updated: Nov 1, 2022

Insurance can be expensive and frustrating for both consumers and providers. When we pay a lot for insurance, we want to get something back in return. One of the first questions patients often ask us is “Do you take my insurance?”.

With the ever changing health care landscape, many clinicians are moving towards the trend of cash based physical therapy (aka out-of-network). One big reason the cash pay model is so appealing is because it emphasizes quality patient care over quantity patient care, while removing the headaches and restrictions associated with insurance based care. In short, our practice is patient focused!

Our ultimate goal at Core Physical Therapy & Performance is to reinvent traditional PT, to get away from the dictatorship of insurance, and to change the way people view healthcare and their own health. We feel all patients should achieve 100% of their goals and function, but that does not always align with insurance goals and traditional PT models.

If you have ever been to PT before, you may have noticed you were in a large room while your physical therapist was also treating 2 or 3 other patients at the same time. Did you feel like you got the attention you deserved? You may have also been told your co-pay was “x” amount but then got a bill a few weeks later saying you owed more money. Or how about feeling like you weren’t 100% better but were told you have “no more coverage” and were discharged? How did that feel?

In a nutshell, the cash based model of PT entails the patients paying a flat fee per visit directly to the practice for the rendered services. Once treatment is completed, you are given a “SuperBill” which is a paid invoice that has diagnosis and treatment codes (ICD-10 and CPT codes) attached. This superbill can then be submitted by the patient to their insurance company for a direct reimbursement or apply payments towards their deductible if it has not been met. This means that all the money you’ve been spending on health insurance is not a complete waste!

So what are the benefits of choosing cash-pay services?

  • Focused Care:

    • With cash-pay PT you get 100% individualized care. Your treatment sessions are 1:1 with a Doctor of Physical Therapy for 60 minutes - you won’t find an aide or tech here. This focused attention allows us to get to know our patients and their goals, and tailor treatment specifically to them.

  • Accessibility:

    • If you live in a mid-large size city, chances are you may have to wait to be seen by your typical in-network clinic for weeks. If pain has you sleepless or unable to do the things you love, waiting around can be daunting and frustrating. Once you access care through your insurance, there will likely be restrictions on visits you are allowed. With the cash model, we likely will be able to see you within a few days. Imagine!

  • Achieve Faster Results:

    • Patients sometimes don’t see the big picture when it comes to their care. This is not because of education, it’s because of the hidden insurance regulations. Most practices will want to see the patient 2-3 times per week and with a copay average of $30-$50 per visit - that equals $90-$150 per week. However, cash based practices have the flexibility of scheduling the patient 1x/week for longer sessions, providing higher quality care. Longer sessions plus better quality of care equals faster results! So, in reality, the $150 in copays is comparable to the price as one session with a PT at a cash based clinic.

    • People think seeing a PT 3x/week is better and you get more for your money. WRONG! Think of it this way, you see a PT 3x/week for 8 weeks versus seeing a PT 4 times in 4 weeks. Cash based practices focus on getting you healthy faster without having to jump through the nasty insurance hoops, with the perks of also saving you time! No need to miss work or school to get to an appointment, or take time away from all the other things you enjoy doing in life!

  • Less Restrictions on Visits:

    • When you use your insurance, you may only be approved for a couple of visits. What if you are going to need more visits or a longer window of time and your insurance won’t cover it? Paying cash for your PT services puts you at the helm of determining what kind of care you need, not your insurance company. You are in control!

  • Shop Local:

    • Going to a private cash based clinic offers you the opportunity to support the local economy. As a local cash based clinic, we are not outsourcing jobs. We are not part of a big franchise. We are here to help the community in any way possible and are likely to support other small businesses as well!

  • Bonuses:

    • You can use HSA/FSA funds as forms of payment! Don’t let that money go to waste!

    • You can submit cash based services to your insurance company for reimbursement! We provide all the documentation you need as proof of payment and proof of treatment (the Superbill we discussed earlier!) in order to file for reimbursement. We highly encourage our patients to check with their insurance provider to see if they cover out-of-network physical therapy services. Many times they will!

Our parting advice to consumers is to remember you should be in control of your health. You should be able to decide where you want treatment. An insurance company shouldn’t restrict you from getting the best care possible. We comparison shop most things in life, why would PT be any different?

If you have questions, we have answers! Email or call us at 857-267-6033 to see how we can help!

  • Dr. Dina Lucchesi, PT, DPT, CSCS


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