The following question/statement is one I commonly hear so I felt it was time to post my answer for all to see … “How are you convincing patients that choosing self-pay physical therapy is financially better for them than their insurance-based options? I understand the promise of longer sessions and higher value attention as it relates to results, but how do you justify it for them mathematically?”
Great question, and it’s something I do address in my Austin cash-based practice! Some components of the answer are pretty straightforward, but some of it is quite variable and you’ll need to know how to help prospective patients “run the numbers” based on their individual insurance/financial scenarios. These numbers will also change based on what you are charging, but let’s look at some hypothetical examples and you can adjust the numbers where appropriate.
For those who do not have insurance (which is quite rare at my clinic) your rates will often be lower than what they will have to pay at an insurance-based clinic, so the numbers are pretty simple and usually not a hard sell for these patients.
Cash-Pay PT for those with a High Deductible
Similarly, for those with a high deductible, they will likely be paying as much or more for each visit to a standard insurance-based clinic until that deductible is met. It is easy to convey the logic of going cash-pay for the longer one-on-one visits and higher-level care you can provide in your cash practice. Also, make sure to let them know that your clinic’s receipts can be sent as self-claims to be applied toward the deductible the same way they would if the insurance-based clinic sent them. (Please note: some insurance plans have in-network AND out-of-network deductibles in which case the application towards an out-of-network deductible is not as much of a selling point since most people are only concerned with meeting their in-network deductible.)
Cash-Pay PT for those with regular Insurance and Copays
If they are paying a copay for PT (let’s say $25/visit) but only receiving about 30 minutes of one-on-one care (usually less), and being asked to get 2-3 treatments a week for 6-8 weeks. That would equate to $300 on the very low end and $600 on the high end. Let’s say with your treatment techniques and longer one-on-one sessions, you can get the same results with one treatment per week for 4-6 weeks, charging $100/visit; the range they’d be paying you is from $400 – $600.
So the amounts they pay can end up quite similar, and depending on how quickly you can get them better (and how high their copays are), they can actually save money by going the cash-pay route. You of course cannot guarantee this for every patient, but you do need to mention that this is a common scenario.
Something else to consider (and remind them of) is the TIME cost of having to go to the PT clinic for so many more treatments when using insurance. What is it worth to them to have 25-50% fewer trips to the PT clinic? What would that added time and productivity mean for them?
Let’s also not forget about the value of feeling better sooner. If they get back to their sport or beloved activity a few weeks earlier, that carries a huge value for many people. What would it mean for their productivity at work if their pain with sitting is resolved twice as quickly because they went out-of network to your clinic? Though we are veering away from actual financial amounts here, it should still be brought to their attention (on your website, when you’re speaking with prospective patients, etc), because this is a significant point.
And finally, don’t forget to mention that your services are HSA/FSA-eligible medical expenses, just like any other PT clinic, so they should consider the savings of being able to pay with pre-tax dollars (if they have an HSA/FSA plan). Here’s a hypothetical example of this savings: $100 treatment fee x 25% tax bracket x 7.65% medicare/soc sec tax = $32.65 in savings … somewhat equivalent to only having to pay $68 for your treatment sessions.
Most of the above points, of course, rely on you being able to consistently get people better faster than the average PT who is limited in the time they can spend with each patient. If you are not providing a service that is truly higher value and more effective than the average, insurance-based offerings in your area, it doesn’t matter how the math works out. This is a keystone of the success of any private-pay physical therapy practice. But if you produce results, you’ll find many people are willing to pay out of pocket.
Did I miss anything? If you have other points you use to financially justify your cash-pay PT services, please leave them in the comments below and share this post with your colleagues.