Why We Don’t Bill Your Insurance Directly
We (Renee and Jackie) knew early on that we wanted to help people. In the early days before Shift PT was ever a thought, we were graduating from our programs (Renee -Doctorate Degree for Physical Therapy, Jackie Associates Degree for Physical Therapist Assistant). Eager to begin helping people, we both started our careers in nursing home type settings. After a couple years of experience, we made the move to outpatient physical therapy care. It was here that our knowledge of insurance coverage related to physical therapy services really grew.
You can imagine that in 11+ years in the field of physical therapy, we experienced many changes when it came to insurance coverage. Here are just a few that are related to why we don’t bill your insurance directly.
High Co-Pays and Deductibles.
Slowly and then not so slowly, patients were expected to pay higher co-pays, deductibles sky rocketed, and reimbursement for services by the insurance companies went down. Meaning, patients were paying more for their care while physical therapy providers were getting paid less by the insurer.
It was not uncommon to see a patient pay a co-pay of $30-$50 for each visit and have an INDIVIDUAL DEDUCTIBLE of $4,000. Patients are paying out of pocket for services even with insurance coverage until their deductible is met. AND, remember I mentioned above, reimbursement rate for physical therapy is going down.
This forces physical therapy providers to treat more patients in a shorter amount of time and more frequently throughout the week to pay for expenses related to providing patients with the best care possible.
Quality vs Quantity.
If you talk to any physical therapy provider, one of the things we pride ourselves on is the fact that out of any other healthcare worker, we get the MOST TIME with our patients. Now we are being asked to spend less time with our patients in order to get more patients in the door because reimbursement rates are declining. How do you make up for a deficit in payment? Add more volume.
As you can imagine, the quality of care decreases the second you start maxing out the total volume of patients you are seeing. I am going to say it again… patients were paying more for their care (even with insurance), while providers were getting paid less and now the time and quality of care is getting cut to make up for the deficit in payment.
Doesn’t seem fair? We are just getting started.
Care is being delayed.
In the state of Minnesota, you are allowed Direct Access to a Physical Therapist. This means you do not need a doctors order/referral to see a Physical Therapist. EXCEPT when….
Your insurance plan requires it before they will cover services.
Yes, your insurance plan can dictate and require you to see a doctor (primary care physician), to go see another doctor (physical therapist) before they will cover services.
Remember Physical Therapists are doctors. They are doctorate level health care providers. Experts in musculoskeletal injuries. Experts in the body’s movement and injury. The best possible health care provider for you to see when you have an injury. The state of Minnesota recognizes this to be true by allowing you direct access to them.
But your insurance can say NOPE. Go see a primary care doctor first.
What does this mean for your care? It means an extra visit to your primary care doctor which means more money out of your pocket and more time that passes before you ever get to actually address the injury.
It delays your ability to get care faster. We all know early intervention is key.
Not all things are covered.
Your insurance plan might cover physical therapy however not all treatments provided in physical therapy will be covered. Read that again!
Certain treatments that might be the best option for your care are not always covered by your insurance and (sometimes) your insurance can determine how you receive that care. For example, in physical therapy (under some insurance plans) you can not do manual therapy (hands on treatment) and certain activities in the same session even if it will give you the best results.
Again delaying your ability to get better, faster. All the while… money is still being spent with each visit.
Why we don’t bill your insurance directly…
When we decided to open Shift Physical Therapy and Wellness we wanted to lead with quality in our services. Although we do not bill your insurance directly, we do see individuals who have health insurance and choose to self submit for reimbursement. These patients are getting paid directly by their insurance provider and minimizing the barriers to get started in your immediate care for physical therapy.
This allows us to focus directly on YOU as the patient. It also allows us to see you right away, without a doctor’s order. We are able to see you for a full hour appointment and because we get that time with YOU, we do not need to see you as frequently.
Also, because we are not restricted to what insurance will or will not cover for services, we are able to provide you with the best care possible (this means the world to us). What this means for you as the patient, is that you get better, faster resulting in less visits needed and ultimately SAVING YOU MONEY in the long run.
We are here to support you, advocate for you, and provide you with the best service possible. The best way for us to do that is to provide you with the tools you need to get directly reimbursed by your health insurance (if you choose to) and we can focus on YOU!
Find out what patients are saying about us.
If you are ready to make the SHIFT. Reach out by phone, email, or complete a free consultation. We would be happy to sit down with you to determine if we are the best fit for you!
Phone: (763) 645 - 1113
Email: info@shiftpwell.com
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Written by: The team at Shift Physical Therapy and Wellness
