Cash-Based Care in Pelvic Health

Hello, Bestie! I hope this chat finds you in the middle of a lovely week. Today, I wanted to switch gears a little bit. We have had lots of conversations about pelvic health. We’ve talked about what it is, what conditions fall under the pelvic health umbrella, and common treatments for a range of pelvic health conditions. While we still have loads of conditions to cover, I wanted to spend this week talking about why so many pelvic health physical therapy providers operate a cash-only business model.

There are lots of pelvic health physical therapists working for companies that accept medical insurance to cover the cost of treatment. However, sometimes folks receive better care under cash-based providers. Let’s talk about why cash-based services are so popular in pelvic health and what this means for you, the patient.

Reasons some pelvic health physical therapy clinics choose to accept cash payment rather than insurance (in other words, these clinics are out-of-network with all insurances):

1.     Pelvic health physical therapists spend more time with their patients per treatment. If you’ve been to physical therapy for, say, shoulder pain, you probably worked with your physical therapist directly for 15-20 minutes before moving onto exercises by yourself or with a physical therapy aide and then using ice or heat. Insurance companies reimburse per patient, so therapists need to see two to four patients per hour in order to have income. In pelvic health, treatment sessions are almost always one hour or, at the very least, 45 minutes, and you spend the entire treatment session with your therapist. Insurance companies don’t pay more if your therapist spends more time with you (well, they do, but not by much and for the sake of this point it is important to understand that insurance companies value quantity much more than quality or time spent—treating four patients in an hour will make you a lot more money than treating one patient for a full hour under most insurance plans). These companies value quantity above all else. In order to make any money at all, the therapist would have to see two to four patients within an hour in order to receive the same reimbursement from insurance that they get in a cash-based clinic.

2.     Pelvic health physical therapy appointments are more spread out than other physical therapy visits. Going back to our shoulder pain example: you would probably go in for treatment upwards of three times per week. In pelvic health physical therapy, you will most likely be seen by your provider a maximum of one time per week. Sometimes, patients are only seen once every other week, or even once per month. Imagine you see your physical therapist three times per week for shoulder pain, and you pay a $35.00 copay each visit. If your pelvic health physical therapist charges $100.00 per visit, and you see them one time per week, you’re still paying less per week for the pelvic health care than you are for the shoulder treatment. Pelvic health physical therapists spend an hour with their patients, which is highly unusual in the medical field. You may be paying more per visit, but you are getting more quality time with your medical provider than you have likely gotten with any medical provider, ever.

3.     It may actually be cheaper for patients to pay cash instead of using insurance. Let me explain. Most insurance companies will have a deductible that patients must meet before the insurance will start paying for the cost of care. This deductible can be anywhere between $500.00 and $10,000. Let’s say your deductible is $700.00 and you are going to an in-network provider that charges your insurance $120.00 for each visit. You will be in charge of paying the $120.00 visit fee until your deductible is met. This means, you should meet your deductible by the end of the sixth visit. After that, you will likely still have to pay a copay each visit, which could be anywhere between $20.00 and $80.00. Let’s say your copay is $50.00. If you end up needing 8 visits in total, your out-of-pocket expenses for care would wind up being $800.00 ($700.00 for the first 6 visits before insurance kicks in, and $50.00 per visit copay for visits 7 and 8). If you, instead, see a pelvic health physical therapist that only accepts cash, the cost per visit could be as low as $80.00. For 8 visits, your total out-of-pocket expenses would only be $640.00. Why would the cash-only therapist be charging $80.00 per treatment session when the insurance-based clinic is charging $120.00 per treatment session? Insurance-based clinics have higher costs and typically need to hire additional personnel who do the work of sending bills to insurance companies, making sure patients have in-network insurance plans, and talking directly with insurance companies when issues arise.

4.     Cash-based clinics are able to maintain transparent prices. How many times have you gone to the doctor, with insurance, but didn’t know how much you would end up having to pay out-of-pocket? Sometimes you get a bill in the mail a month later and only then know how much you still owe after your insurance paid their portion. Even if you have insurance, it doesn’t guarantee you won’t have to pay part of the medical bill. It is common for insurance companies to pay for a portion of the medical bill and leave you in charge of the rest. Many insurance companies will cover 80% and require you to pay off that last 20%. I was recently talking with one of my fellow pelvic health therapist besties who brought up a perfect example of the lack of price transparency in insurance-based clinics. She had been treating a patient whose insurance was in-network with her clinic. However, due to various factors, the patient was not sure if insurance would continue to cover her treatment and she wanted to see how much it would cost if she paid out-of-pocket. The clinic told the patient it would cost her between $498.00 and $875.00 if she were to pay out of pocket. Obviously this is completely ridiculous. First, the price is astronomical, and second, why the nearly $400.00 price range? It can be difficult for insurance-based therapy clinics to provide accurate out-of-pocket expenses to patients. This is because they don’t know what treatments the therapist will do with the patient and they have a set amount that they charge for each type of treatment. This is starting to change a bit, with some insurance-based clinics offering patients a cash rate, but it is not yet standard practice. Cash-based clinics offer transparent pricing. They have standard prices that are the same for each treatment session, regardless of treatment.

Story Time: While working in an insurance-based clinic, I once had a patient (who had insurance) that I was treating one time every 1-2 weeks. I saw her for about four or five visits before she got the bill for our first treatment session in the mail. The bill was for the percentage of treatment cost she owed back to the clinic that was not paid for by her insurance. This bill was so high that she immediately had to halt treatments. She had to focus on paying off the bills for our first four or five sessions together. This was a patient who had insurance and was seeing a provider that was in-network with her insurance. Yet, due to the lack of transparency in prices at most insurance-based clinics and the nightmare it is to try to understand one’s own benefits, she was faced with a large bill and out-of-pocket costs that ultimately forced her to stop treatments.

I have a few more reasons I want to discuss, but I need a coffee-break. Let’s pause here and keep this conversation going next time! Thanks for listening, Bestie.

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.