Why I Don't Take Insurance (And Why It's to Your Benefit)

Long before I opened my practice, I debated heavily on whether or not I should take insurance. I wanted to be as accessible as possible, but I also saw some things that concerned me greatly involving insurance. Below is an explanation of why I ultimately decided to be out of network.

I frequently hear from my patients that they are frustrated with long wait times, limited coverage, short appointments, limited information from appointments that leads to confusion about their condition, limited improvement, a lack of tailoring treatment to their needs, and generally feeling let down by their healthcare providers and insurance companies. 

This stems from many things. One of those is reimbursement policies from insurance companies. Different kinds of physical therapy treatment are reimbursed differently. An example is that neuro rehab is reimbursed more than therapeutic exercise. For each subsequent “unit” of time spent with a patient, the physical therapist is also reimbursed less. They literally lose money after 22 minutes for doing the same treatment. This leads to overlapping patients and shorter treatment times so that the clinic can still make enough money to pay the bills. Oftentimes, clinics will employ physical therapy techs to carry out much of the labor to save on costs, setting patients up on exercise machines while being “supervised” by the physical therapist across the gym. It’s all technically legal, but it’s a far cry from ethical.

Private physical therapy practices also are reimbursed significantly less than hospital-based practices, making it an even greater challenge to stay afloat. This is why more hospital-based clinics have longer treatment times and don’t use physical therapy techs, they don’t have to. 

Insurance companies will delay reimbursement, often for months, driving the private clinic into bankruptcy. Churning through patients is one way to help stave this off.

Another reason is insurance limits coverage for treatment to the point that physical therapists cannot address the injury/problem in its entirety. Meaning, a patient may reach 75% of their previous functionality and then insurance stops covering their therapy. The patient can have shoulder pain, but their problem can be originating from their low back scoliosis, and so insurance won’t cover treatment that isn’t focused on the shoulder. Basically, a patient is only allowed to be sick so much before insurance will stop covering their healthcare.

To fight these limitations, large clinics and hospital-based clinics hire staff solely to pursue payment and coverage from insurance. Small clinics cannot afford this, leading to loss of money, a loss of coverage, and burnout. Physical therapists will often take unpaid time to fight for their patients, making phone calls during their lunch for peer-to-peer reviews with insurance to explain why the patient needs treatment coverage despite the reasons already being in the note. Insurance will often only look at one or two data points to determine if the patient is still in need of coverage, ignoring the lengthy write-up the physical therapist has constructed to explain their patient’s condition as a whole. 

Another reason is that our education, while lengthy and detailed, also focuses primarily on orthopedics more than anything else. This leads to a limited understanding of other conditions and requires the physical therapist to take on extensive education after graduation to ensure they know how to treat their patient. This can be expensive, and therefore prohibitive based on an what insurance reimburses, leading to few physical therapists who can address other conditions (think pelvic floor health or fascial work as examples).

In short, I have chosen to provide physical therapy out of network in order to stay aligned with my values and ethics for patient care. This allows me to address a person’s needs as they arise rather than being isolated to one part of the body at a time. Paying privately also allows me to treat for longer periods of time per session and allows me to treat a person for as many sessions as they need to heal. Treating someone for longer sessions provides more time to address all aspects of care, and reduces the number of appointments needed to achieve the patient’s goals. I am also available much sooner than many other clinics due to having more freedom with my schedule. My continuing education does not suffer due to having the necessary funds, allowing me to stay up to date on treatment practices in my specialty. 

I also don't want to forget the quality of life aspect for myself. If I am burned out with no ability to recover due to the constant and ever-increasing grind, how can I be a good healthcare provider? I have lived that life, and I have seen it in my friends and family. It is terrible to loath a job that was once so greatly desired. Hearing patients lament about their doctor never looking at them, hearing them, or responding with compassion is heart breaking. That comes from burnout. We lose practitioners to this every day.

Being able to practice in alignment with my ethics and needs allows me to continue serving my community to the benefit of everyone involved.