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  • Dr. Kristen K. Schulte, PT

What is your health insurance doing for you?

Updated: Jul 7, 2020

“Do you take my insurance?” is the #1 question I get from inquiring patients. The truth is, no. 212 is considered “out of network” with all insurance companies. Now, before you click the back button on your browser, hear me out because this isn’t about 212 being out of network. This is about making you a more educated consumer.

Have you ever received a bill weeks after an appointment and thought, “Hmmm. I was not aware that I would owe that much.”? I certainly have.

Lesson learned, at my next appointment I asked the front desk employee for an estimate. Her response? “I can’t say for sure. It depends on what happens during your appointment today.” She could, however, tell me that I owed a $40 copay.

Okay fine. In my appointment, I engaged my provider on cost. He did not know either because it “depends on how much your insurance will pay.”

The damage was done (again), but I still called my insurance company after the appointment. They too could not tell me exactly how much I owed because my physician’s office had not yet billed. They were only able to tell me that because my deductible was not met, I was responsible for the total sum of the visit.

It’s a common theme in healthcare. The left hand does not speak to the right, and no one can tell us exactly how much is owed beforehand. We are constantly forced to pay a copay and swallow the cost (whatever that may be) when billed later.

Reason #1 that I chose for 212 to not bill through insurance was so that the patient could know up front exactly how much is owed for each session. At the end of a session, patients hand me their HSA card, credit card, cash, or check. The transaction is complete. There is nothing to be billed later. It is the same price every session, no matter the treatment performed or equipment used.

Reason #2 is because it saves the patient money. A visit to 212 may actually be cheaper per session for many with mainstream insurance (Anthem, United, Medicare, Medical Mutual, Aetna) than visiting a PT clinic that “takes insurance”. Certainly, coverage varies per plan, but I have found that most of these insurance companies pay about 80% of the total billed for a physical therapy visit before the deductible is met. Physical therapy copays for these providers range from $20-60. Stick with me for the math:

Area outpatient physical therapy clinics bill around $200 for a unit of physical therapy (1 unit = about 15 minutes). Visits tend to be 30-45 minutes, which means 2-3 units. I will work the low end of the estimates:

2 units billed at $200 each = $400

You are responsible for 20% of the billed amount= $80

You also had a $40 copay due at the time of visit

That brings the total amount you pay for a 30-minute session to = $120

If I break down the total cost of a visit at 212, it currently equates to $20 a unit. We see patients for 55 minutes. Now you do the math 😊.

Reason #3 is because it saves the patient visits (and therefore money). Have you ever gone to a provider and been signed up for multiple visits from the start? I have worked other places. I know how it goes: Most patients are scheduled for 2x/week for 6-8 weeks. I am now tired of doing math, but if you multiply the sum from earlier ($120) by 16 visits, you will find that that total number is not cheap.

At 212, we unfortunately do not have the super-power of defying physiology. For a muscle to gain strength or a bone to heal, it takes 6-8 weeks. It is what it is. While you can still expect to wait the magic 6-8 weeks for real change, that does not mean that you need to be coming in consistently for that amount of time.

Unless it is an exceptional case, I rarely see patients more than once a week. Why? I teach you corrective exercises to do at home. During your visits, we will work to normalize tissue and mechanics, and then it is your job to build in the strength in the meantime. Together at each visit, we assess how you are doing and plan the course of action accordingly: Do we keep it at once a week? Do we space it out to every other week? In some cases, I just ask that you call in a couple of weeks and let me know how you are doing. There is no “one size fits all” prescription for physical therapy, so frequency and duration of treatment is determined on a case-by-case basis and as a conversation between patient and physical therapist.

There are a lot of variables in the numbers that I used. You may have met your deductible, or you may have a secondary insurance, both which will skew the numbers. Some clinics may charge more or less per unit. The numbers I just presented were collected via my own research as both an insurance consumer and a healthcare provider. The only promise that I can make is what you will pay at 212 every last visit. And I urge everyone who first asks the question, “Do you take my insurance?” to first ask themselves what their insurance is doing for them.

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