In a cash-based treatment model, the Physical Therapist provides the patient with physical therapy services that both parties have determined will help them reach treatment goals most efficiently. The patient pays at the time of service, allowing the therapist to focus attention on providing the best possible service while keeping administrative costs low. You may pay for services using your HSA account, actual cash, check, or a credit or debit card. Our goal is to spend more time with patients and to allow patients to take back control over their healthcare choices. Today’s healthcare consumer has become emboldened to know what care costs and are demanding more transparent pricing.
Under insurance-based circumstances, medical coding for physical therapy services provided (CPT codes) is determined using a complex matrix of "timed codes" and "untimed codes". This often results in confusing patient bills, as the amount billed to insurance will vary visit to visit based on the exact services provided that day. Cash-based billing eliminates this confusion and allows for clarity in decision making on the part of the patient and their physical therapist. Documentation for evaluations, treatment visits, and progress notes are performed just like any physical therapy practice and comply with all legal requirements.
WHAT ARE THE BENEFITS FOR PATIENTS?
-Cost effective-
Physical Therapists have the extensive education and training to be neuromuscular primary care experts. For the majority of patients’ with movement or pain problems, Physical Therapists are often the provider of choice. For people with high deductibles, it makes financial sense to pay a Physical Therapist directly for a comprehensive evaluation and treatment.
In many cases, the out of pocket expenses for a course of physical therapy will actually be LESS for services provided at EverStrong Physical Therapy. In large part, this is due to the ability to charge less per visit, with these charges being well below the national average charge submitted to insurance in a typical fee for service outpatient practice. EverStrong Therapy can charge less because the simplified cash-based fee structure streamlines billing and does not require hiring billing personnel or paying fees to a third party billing service. This allows EverStrong Physical Therapy staff to focus all energy on patient care, and allows patients to make informed decisions regarding the costs of their health care choices.
Additionally, with a growing trend towards companies providing high deductible insurance along with an HSA option, a cash-based Physical Therapist may be your best option as you can your your HSA to pay for your visits.
-Accessibility and Shorter Wait Times-
In the state of Washington, Physical Therapist have direct access. Patients typically have a shorter wait times in a cash practice, the sooner the patient is seen the better the outcome.
-Transparent Pricing-
For the self-pay patient finding therapists who offers fair, simple and transparent prices is crucial. Cash based pricing eliminates the added administrative costs when submitting claims to insurance companies. No more “We’ll send to insurance and see what they pay” when both parties know that the charges are coming out of the patient’s pocket.
-Patient-Therapist Relationship-
EverStrong Therapy is a practice where we don’t demand your insurance card and ID before we will even speak with you, it doesn’t get in the way of patients getting to know their our practice and Physical Therapist.
Taking insurance middlemen out of the equation allows therapists to spend more time directly with patients. This is opposed to having to abide by rigid insurance guidelines and time spent based on insurance coding dependant on your individual provider.
-All Patients Are Welcome-
All patients, insured or uninsured, in network or out-of-network are welcome. Payment is by cash or charge. Patients aren’t rejected because of their insurance carrier. Cash practices that are designed for self-pay patients are free from outside interference to address the circumstances and needs of individual patients, not what insurance deems allowed or necessary.
CAN MY INSURANCE BE BILLED FOR CASH-BASED PHYSICAL THERAPY SERVICES?
Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide payment for services received "out of network". Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. Many patients choose to receive services out of network in order to see the physical therapist of their choice and often without long wait.
EVERSTRONG THERAPY IS AN OUT OF NETWORK PROVIDER - WHAT DOES THIS MEAN?
This simply means that EverStrong Therapy has not entered into a contract with individual insurance companies to receive reimbursement based on their contracted rates. There are many insurance companies, each with their own contracted rates and regulations, and EverStrong Therapy’s energy is best spent working with patients. It is important to note that in network provider status is not currently based on education, experience, skills, or treatment outcomes, but is often determined by the number of providers in a demographic area.
WHAT STEPS ARE INVOLVED IN SUBMITTING A CLAIM TO MY INSURANCE COMPANY?
The process is actually quite simple: EverStrong Physical Therapy will provide you with an invoice at the time of service, and you may submit that invoice and receipt to your insurance company for reimbursement. The invoice has all of the necessary information (business name and address, tax ID, national provider identification, license numbers, etc.) as well as the patient’s ICD-10 (diagnosis) and CPT (billing) codes. You may choose to submit bills following each visit, one time per month, or at any other interval, typically up to one year following your treatment visit.
