Is Our Physical Therapy Covered by Insurance?
Is Physical Therapy Covered by Insurance?
Since the day that we opened, Kinetic Sports Medicine and Performance has been out-of-network with all insurance companies. However, that doesn’t mean our physical therapy isn’t covered by your insurance.
It was a deliberate choice, not driven by any financial reason, but out of a true belief that this model allows us to put patients’ needs first (specifically active athletes and adults).
Why do we feel it is necessary to be out of network?
There are multiple components to this and why we feel it is in your best interest.
- We work for you, not your insurance company. Insurance companies do not care about your performance, and they do not care if an athlete can return to their prior level of sport. They just care about your ability to complete your everyday activities like walking, lifting things onto shelves, going up and down stairs, etc.
They do not care if you’ve recovered your previous fastball velocity, if you have the same speed on the field or if you can get back to hitting your bench press PR.
We want to work for you on your goals, not your insurance companies’ goals. We want to help you not only return to your sports and activities but return to performing at a high level.
- It lets us be more efficient with your time. Now more than ever, time is our most valuable asset. Whether you are an adult that is balancing exercise, recreational activities, job and family time, or a high school student balancing school, homework, friendships, fun, working out, club sports and high school sports, time is precious.
Our model allows us to see you one-on-one with a physical therapist for 60 minutes typically 1 session per week or 1 session every other week. On average, for a non-surgical condition, we see patients for 8 visits over a span of 2-3 months.
This is very different from a traditional in-network physical therapy model that will see you 2-3x/week for 6 weeks. During those sessions you may be in the clinic for 60-90 minutes but will typically only see your physical therapist for 15-30 of those minutes as most in-network practices have to double book therapists and use aides and techs to help manage the high volume of patients that therapists see.
One model is not necessarily “better” than the other. But they are very different. Patients that are successful with us value their health, wellness and performance. They are motivated and keep up with their ‘homework” in between visits.
They also value their time and appreciate having to make less frequent visits to our office!
- It limits waste. A recent study published in the Journal of American Medicine looked at the percentage of medical costs that are associated with waste. Currently, healthcare costs account for 18% of the United States GDP, and of that, 30% of the spending was considered waste.
That amounts to $760-$930 billion per year in healthcare waste!
Our model allows us to be more efficient with our staffing, our overhead, and focus all of our time and energy on you and your goals.
- You are more than just a number! Our model allows our staff to see 5-7 patients per day. This gives them adequate time to focus on you, prepare for your sessions, stay on top of the research and ensure we are providing the best possible care.
Our 60 minute sessions also allow us to get to know you, spend time with you and learn more about you. You end up being much more than a number, becoming a part of our Kinetic Family!
Does Out-Of-Network Mean More expensive?
No, not necessarily.
We have all been trained when we call a medical provider to ask, “Do you take my insurance?”
As I have gotten involved in and been in the healthcare field for over 12 years now, I have learned that this is the wrong question to ask.
As you look for a physical therapy clinic, naturally you wonder if these physical therapy sessions will be covered by insurance. But just because a facility or provider takes your insurance does not mean that care will be inexpensive.
You need to understand your benefits:
- What is your deductible? (both in- and out-of-network)
- What is your out of pocket max?
- What is the co-pay or co-insurance?
- If you have a co-insurance, what are the typical charges they run?
- If you haven’t met your deductible, what is the typical cost of a visit until you meet your deductible?
There is a common misconception that if you use your insurance, your care will be free. That isn’t the case. At a minimum, you will have a co-pay or co-insurance, which is typically between $40-$70/visit for physical therapy.
Then, on top of that, you will be responsible for any charges the insurance company doesn’t cover.
And if you haven’t met your deductible yet… Your first visit could be between $500-700!
We have had several patients that started out working with an in-network physical therapy clinic that then transferred into our care as it was a better fit for their needs. One story in particular stands out with a veterinarian that was recovering from an ACL injury.
She started at an in-network practice that her surgeon recommended for about 6 weeks before transferring to our care. About 1 month into working together, she received a bill for $4,660 from the physical therapy clinic because she had not met her deductible and some of the billing codes utilized were not covered under her health plan. This was more than the entire course of treatment with us was going to be over 6 months!
I felt terrible for her, and it drove home the point to me that we need to help patients understand that the right question to ask isn’t “do you take my insurance?” but rather, a more detailed series of questions on the actual costs associated with care.
| Out-Of-Network | In-Network | |
| Per visit cost Up Front | $150-200/session | $50-70/visit |
| Time With Physical Therapist | 60 minutes | 15-30 minutes |
| Average Number of Visits | 8 | 12-18 |
| Total Time Spent with PT | 8 hours | 9 hours |
| Average Total cost Up Front | $1400 | $1080 |
| Costs after sessions | $0 | $$$ (in surprise bills 3+ months later) |
As you can see, there is a slight difference in cost over time, but you spend a lot less time and effort driving to physical therapy clinics to get a more personalized approach and the best possible outcome for your specific goals.
We can also be 100% up front and transparent with our costs with no hidden bills or fees months after your care ends.
Can I Get Reimbursed for Out-Of-Network Visits?
Yes!
A lot of people are nervous about physical therapy being covered by insurance, but what they don’t realize is that you can often be reimbursed for physical therapy sessions, even when they are out-of-network.
You are able to use HSA/FSA accounts with us. Additionally, we give you all of the documentation necessary to submit for out-of-network reimbursement from your insurance company.
Reimbursement varies from plan to plan, but we have seen many patients receive 40-60% of the costs of care back. In these situations your insurance company sends you the check directly.
Is The Care The Same?
This is a tough question to answer as I know there are great physical therapists in all models. However, sometimes there are constraints put on physical therapists by insurance companies, and by productivity expectations within their clinic.
What I can talk about is what we do.
We invest in having cutting edge technology to gather objective information that allows us to build individualized plans. Our staff regularly takes continuing education courses to stay on the top of their game. And, each week, we have “grand rounds” to discuss cases and learn from each other to ensure we are providing the best care in the midwest.
We have the time to spend with you to truly understand your situation, your goals and personalize our approach to you.
We have the time to plan for your session, follow up with you after your session and check in with you between visits.
One of our core values is “We Care.” And you will not find a group of people that cares more about you, your goals and your situation than us at Kinetic.
Conclusion
There is no “right” model of physical therapy for everyone. But, there is a better fit for you and your needs. When you ask, “Is your physical therapy covered by my insurance?” don’t turn away when you hear out-of-network!
I hope this article is educational or eye opening, and allows you to ask better questions to truly understand your options and the costs associated with each. That way you can make a fully informed decision and select the right place for you to recover from your injury, return to your sports and activities and achieve your prior level of performance.