ADVANTAGES OF SELF PAY

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I do not bill through insurance; I charge patients directly for treatment.

 

Musculoskeletal conditions are the leading cause of disability in the United States, affecting more than 50% of the US population. One of the most common reasons for seeking medical care is a musculoskeletal condition – about 85% of people with musculoskeletal conditions have at least one visit with a primary care provider and average 6 visits a year (1).

 

 

• No limitation of care: Insurance companies determine what conditions are covered, some only cover a diagnosis once per lifetime. Any condition that is not deemed medically necessary is usually not covered by insurance. Many insurance companies do not cover more than one body part/diagnosis at a time. This means that even though you may have two or more areas that are bothering you, or a new issue arises during your current treatment, insurance will not cover treatment for it until you complete your plan of care for the first diagnosis. Most insurance companies also do not cover preventative or maintenance care, which is a very important part of patients’ continued progress and ability to adhere to a home program. Working with me through self-pay, we can determine a plan of care that encompasses the range of things you want to work on and for how long – some people just need help getting started; others benefit from continued guidance as they progress along their path.

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• Comparable fees: It may seem like insurance-based services make physical therapy (PT) “free”, or “cheap”; however, many people have co-pays and/or deductibles to meet before services are covered. Patient co-pays can be as high as $75 per visit, which quickly adds up at 1-2 visits per week. Additionally, PT visits range in cost depending on the facility and insurance type. Thus, it can often be difficult to predict what the total cost of PT when calculating/managing your deductible.

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• No visit limits: Patients are subjected to arbitrary visit limits per year by health insurance companies, which do not account for initial diagnosis or severity, complications, and variability in patients’ progress. Working with me through self-pay, you can have as many visits as we deem beneficial based on your goals.

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• You don’t need a referral: Although Massachusetts is a Direct Access State, meaning people do not need a doctor’s referral to see a physical therapist, insurance companies do require a referral to pay for services, which often times is not medically necessary and requires increased time for patients to obtain the referral.

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• My time is dedicated to you: Increased documentation requirements by insurance companies leads to significantly increased time required for not only documenting services but billing and submitting claims which decreases availability for patient care. Additionally, you will be working with me one on one the entire time.

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• Timely treatment: There are often long wait times to see a physical therapist at most facilities that require insurance, which can sometimes result in worsening of the condition. I will work with you to see you within 1-2 days of contacting me so that we can get you on the road to recovery.

 

 

I want the focus of treatment to be the patient.

 

 

1. Carvalho et al; Insurance Coverage, Costs, and Barriers to Care for Outpatient Musculoskeletal Therapy and Rehabilitation Services; NC Med J. 2017 ; 78(5): 312–314. doi:10.18043/ncm.78.5.312.