Why pay when you have insurance?
After 5 years working in Physical Therapy, starting a practice which is out-of-network with insurance might seem like a bold leap to take. Everyone (almost) has health insurance, and they like to use it. Why pay premiums if you aren’t going to use it? Even working every day in the field, it has taken me some time to digest why going through insurance may not be the best option all the time. So, at the risk of sounding like an unapologetic sales pitch, let’s look at when it makes sense to pay “out-of-pocket" for services.
First, think about the goal of an insurance company. Take in premiums from customers, distribute funds to those who need them to cover large costs, keep some extra to make money. This applies to any type of insurance (car, homeowner’s, medical, etc). What is the goal of the insurance customer? Typically, it is peace of mind that if sudden, large expenses come up you won’t have to drain your savings or take on debt. On one end is a company who needs to make some money, on the other is a customer who doesn’t want to lose all their money.
As a customer, insurance is usually about softening the financial blow from “catastrophic” events. If we look at car insurance, this usually means accidents. In medical insurance, this translates to injuries or disease. In the same way that car insurance does not cover oil changes, brake replacement, or performance upgrades, medical insurance does not cover preventative or performance enhancing treatments. In fact, insurance often fights hard against coverage for these types of services because at the end of the day, they need to make a dollar. Seeking reimbursement for prevention or performance often becomes a headache of phone calls, review processes, and ultimately denials.
Physical Therapists’ training prepares them to address injury prevention and recovery, mobility, strength and conditioning, endurance and functional capacity, pain relief, sport and work optimization, ergonomics, post-surgical recovery, and more. There is a lot of value in the interventions we can provide. Choosing to pursue these in a self-pay model frees the PT and the client from the constraints of the insurance company. The treatment progression, body area of focus, client goals can all be flexible and adaptable without waiting for authorization. And the PT can focus on what they are best at – improving performance and preventing future issues, not just getting clients back to their baseline.
With all that in mind, I challenge you to start thinking differently about your body and health. In the same way that we pay for oil changes to maintain our vehicles, or update our homes to increase their performance, efficiency, and value, start to think of your body as something you should invest in improving. Break free from the repeated cycle of injury to recovery, dictated by the reimbursement from an insurance company who needs to make money from you. Commit to investing some of your time and resources to prevention and constantly improving to become a better version of yourself.
