Cash-Based Care in Pelvic health (Continued)
Hi, Bestie! Last time, we talked about why so many pelvic health physical therapy clinics choose to operate under a cash-based business model, rather than accept health insurance. Today, let’s finish up that chat and hit on a few more reasons we are seeing clinics convert to cash-based models. I really don’t think any physical therapist is out to just make a quick buck. In general, therapists (and all healthcare providers) really want to help people! They found this profession because they wanted to make a positive impact on the lives of others. Keep that in mind as we chat about this topic and remember that cash-based clinics can often benefit the patients as much as they benefit the therapists. Here we go!
More reasons some pelvic health physical therapy clinics choose to accept cash payment rather than health insurance (continued from last chat):
5. Keeping patient appointment times longer and volume lower prevents clinician burnout. Burnout is a huge problem in the medical world. Most healthcare providers became clinicians because they wanted to help people. However, dealing with logistics, billing, insurance, and productivity standards are all things that cause providers to become burnt out and leave the profession. I have worked with physical therapists who see upwards of six patients per hour. This is completely exhausting and does not allow for career longevity. Remember that a physical therapist has many responsibilities aside from treating you during your appointment slot. Your therapist is also reviewing your case before you come in and devising a treatment plan for each day’s visit. They are documenting your session after you leave as well as devising and sending you an exercise program to complete for homework. They’re also communicating with your other medical providers, as necessary. For example, they may be updating your referring provider on your treatment progression or asking about certain parts of your medical history. If your provider has referred you to another provider for a consultation, they may also be contacting that provider to let them know about their referral and answer any questions that arise. On top of this, your physical therapist is constantly reading up on the most recent literature and making sure your plan of care aligns with current research.
There are VERY FEW pelvic health therapy providers in the United States (and all around the world). Every provider I know has a months-long waitlist for patients to get in to see them. We really cannot afford for these providers to get burnt out and leave the profession. Pelvic health providers are already overloaded with the number of patients that want to see them and I know folks who are regularly coming into work early, staying late, or even seeing people on their lunch break to ensure all their patients get the care they deserve. Preventing burnout is essential in this niche and cash-based clinics are one way clinicians have been able to make sure their own needs are met. No clinician can provide quality care if their own needs are not being met.
6. Even if you see a therapist at a cash-based clinic, your insurance might pay for it. I’m not sure if this is well known, but it is possible to be reimbursed by your insurance even if you see an out-of-network provider. Insurance companies have in-network and out-of-network benefits. They have negotiated reimbursement rates at in-network providers and this is why, when you see an in-network provider, the company will cover most or all of the cost. Out-of-network providers have no relationship with your insurance company. If you’ve found a provider you love and they are out-of-network with your insurance, check your out-of-network benefits. It is possible to be seen by the provider, pay the cash-rate that the provider charges you, and then submit this bill to your insurance company yourself. Your insurance company may reimburse you a portion of what you paid for the services. Just because it is a cash-only clinic doesn’t mean your insurance won’t pay for it, it just means you might have to do the leg work to get the money from your insurance.
7. Pelvic health physical therapists are experts in preventative care. Actually, I think most physical therapists are experts in preventative care. We know how injuries happen, so we know the best ways to avoid them. However, certain types of preventative care, such as childbirth preparation, discussions on getting pregnant, preparing for menopause, or preparing for pelvic surgery are not covered by insurance. These items are within the scope of practice for pelvic health physical therapists, but insurance companies do not usually reimburse for preventative care. If you are seeking preventative care, you might find the best care at a cash-based clinic whose treatment plans are not based on what insurance companies will or will not pay for.
8. Cash-based care means fewer re-evaluations. If a therapist’s reimbursement is coming from an insurance provider, they need to follow the standards set by that provider. Most insurance companies require regular re-evaluations of patients in order to ensure the patient is improving. While re-evaluations are essential in physical therapy (we need to know if treatment is working, after all), constant re-evaluations can halt or slow progress. Some insurances require re-evaluations once every 30 days. Here’s why this isn’t always appropriate: If you are being treated for stress urinary incontinence (SUI) and you have pelvic floor muscle (PFM) weakness, you may be working on strengthening the PFMs. Muscles take six to twelve weeks to even begin gaining strength. So at 30 days, you may not notice a significant change in SUI, simply due to the nature of muscle strengthening. Re-evaluations take up precious treatment time and if they show a lack of improvement, your insurance company could fail to approve you for more physical therapy visits.
I hope these past couple of chats have provided you with a different perspective on cash-based physical therapy. It’s not as bad or as inaccessible as it is made out to be. In many cases, it actually benefits the patient. So, what do you think? Would you see a cash-based healthcare provider? Let me know and I can’t wait to chat soon.
XOXO,
Your Pelvic Bestie
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
