Is Physical Therapy Covered by Insurance?
One of the questions I’m frequently asked is whether or not physical therapy is covered by insurance.
It’s a question that makes sense to ask and I’d love to dive into it here. Below, we’ll talk about why I am out-of-network with insurance companies as well as the value of that for you and then lastly, we’ll talk about your options as a potential patient when it comes to insurance reimbursement.
Is physical therapy at Game Changer Physical Therapy covered by insurance?
Inside my physical therapy clinic in Kennewick, WA, I am out-of-network with insurance companies. This means that I do not directly communicate with insurance companies and I do not take your insurance information when you book.
Instead, my model is a fee-for-service, cash pay, or private pay system where each visit you pay me directly for the session in full, rather than paying me something like a copay.
The benefits of out-of-network physical therapy
So you know that I’m out-of-network. But let’s talk about what exactly that means so that you can understand the value of this method.
I am able to treat you based on what I find in your assessment, not based on what an insurance company tells me to treat.
Honestly, can you even believe that an insurance company (and a person who doesn’t have formal training in physical therapy) can tell physical therapists EXACTLY what things they are allowed to do inside of sessions? This is a major reason why I am out-of-network.
These “allowed procedures” are based on protocols and algorithms.
If you’re anything like any of my other patients, you know that this simply doesn’t work for human beings. I am different than you, you are different than your neighbor, and the way anyone responds to treatment or experiences an injury will be different from someone else.
Put simply, what works for your shoulder pain may not work for my shoulder pain.
At the end of the day, this limits the quality of care.
Better outcomes, faster recovery.
When I am able to treat what I find in your assessment and not what an algorithm tells me to treat, I am able to get you better results and you’re able to recover faster. Period.
This is because we’re actually doing what needs to be done.
I can spend 60 minutes with you without sacrificing your results or my ability to keep my business open.
An inside look: physical therapy reimbursement is not great. Because I am out-of-network, I’m able to see 6 people per day and make a livable wage.
If i was in-network with insurance, I would need to see double that and then some in order to keep my doors open.
While this seems like it’s all about me, at the end of the day, this means you will get better care, because I see ONE person per hour. You get my full attention. I am not splitting my time between you and another person, it’s 1-1 the entire time.
Which then leads to better outcomes, faster recovery, and more specific treatment.
I’m able to treat my ideal client: athletes and active folks
Believe it or not, even if I took insurance, you likely couldn’t use it for your physical therapy visits because you’re active and are able to eat, walk, use the stairs, and use the bathroom. Sounds silly, but this is what your physical therapy benefits are actually designed to cover.
Your insurance company doesn’t care if you can’t run, lift, play sports, cut and pivot, or throw a ball. They also don’t care if you can play your sport without pain. But I do and it’s pretty likely that you do, too.
So what happens if you do go somewhere in network in this situation? You’d end up experiencing #5 below (surprise bills) if you tried to use your insurance and then they deemed the care “not medically necessary” in the end. They consider medically necessary things to be the regular activities of daily living like eating, walking, getting in/out of bed, getting dressed, etc.
All that “extra stuff” - you know the fun things like playing sports, running, wake-surfing, skiing, is actually put in the “return to sport” and “performance” treatment category, which insurance deems isn’t “medically necessary.” Because it isn’t medically necessary it means that treatment is covered by many insurance plans - regardless of if pain limits you from doing those things.
However, it’s still a perfectly valid reason for needing therapy. This is how I fill the much needed void in physical therapy care for athletes and active individuals.
No surprise bills for you
What you pay is what you pay here at my clinic. If a session is $200, that’s the full cost. I won’t send you a fee 6 weeks down the road because something popped up.
When you utilize insurance, sometimes you’ll pay a copay, let’s just say $30, and then 6 months down the road after the insurance company goes through the session notes (go back to #1 here), they decide that some of the treatments that were done in your sessions were “not medically necessary” and now they send you a bill for what they didn’t cover.
This could add up to be thousands of dollars. Not fun.
Sessions are typically 1x/week
Because I’m able to determine what your sessions look like, we’re able to get down into the root cause, and I’m able to spend a full 60 minutes with you, you only need 1 session a week.
This means less time away from work, school, or your home.
With insurance-based care, you’re typically going to PT 3x/week for 12 weeks (the arbitrary standard), which means you’re needing to take time off, drive, get childcare, etc. multiple times a week for what ends up being about 2 hours when you account for commute and the session itself.
I understand that alone can be a huge barrier for a lot of folks, which is why 1-1 for 60 minutes 1x/week is much better all around.
What are your options for using your insurance at Game Changer?
When you get treatment at my clinic, it will always be an up-front cost for the session itself. Afterward, you can submit to your insurance to use your out-of-network benefits. They may reimburse you in full, partial, or not at all. This process will be fully executed by you after I send you the superbill for your session.
I also accept other types of payment:
HSA
FSA
All major credit cards
At the end of the day, you get to decide how you want to receive care. You can choose to go the insurance-based route first if that feels better for you. If you’re looking for faster recovery, top notch care, and a provider who will dive into the root cause to help you get better for the long haul (rather than just treating the symptoms), then I recommend a cash pay provider.
If you are looking for physical therapy in Kennewick, my clinic, Game Changer Physical Therapy serves the Tri-Cities area and I’d love to help you. I specialize in working with athletes and active adults and am committed to helping you not only feel better but address whatever we need in order to decrease your risk for future injuries.
You can get started at any time by booking a free discovery call or submitting a contact form.