Wondering why cash-pay is the way we do things at Kaizen? We’ve got two simple reasons:
- In order to spend more time one-on-one, provider and patient.
- Because cutting out the middleman means decreased overhead and the ability to run a practice focused on ONE thing – the patient.
This takes us back to the simple life. Up until the 1950s, this was the traditional model. We want to care for patients the best way we know how. This involves spending time, face to face, listening, assessing, planning, and implementing based on your concerns and your goals. Providing this care as an in-network provider would be tricky. It would require much sacrifice, especially when it comes to time spent documenting, coding, and billing. These things do not impact your care directly and will not help you get better. These are the things that our healthcare system currently has wrong (at no fault of the providers, just a faulty system, unfortunately).
In short, billing insurance requires staff to maintain the transactions with the middleman, which means decreased reimbursement (this varies depending on the insurance company), leading to the increased need to get patients in and out of the door, which requires hiring more staff to care for those patients and increased overhead… and, you get the picture.
Seeing a cash-based physical therapist, out-of-network, can save you money and more importantly, your time! At Kaizen, that means we dedicate each one-hour session to address your concerns and develop a customized treatment plan.
Why out-of-network?
Insurance companies can be very restrictive. In-network PT is typically limited to “treating one body part,” while Kaizen is able to consider the patient as a whole person. We are not big on limitations – neither are you, which is why you’re here. In our experience, third-party payers pressure for immediate diagnoses, then insist on confining treatments, and simply put, interfere with the therapy we want to provide. This often hurts the patient’s progress and hinders our ability to reach his or her goals.
Out-of-pocket expenses over the course of physical therapy will often be less expensive for patients with a cash-based model than through a traditional physical therapy practice. Let’s do some simple math. While it’s hard to use exact figures because everyone’s insurance plans are different, the outcomes are typically the same.
If we take the “standard” protocol in an insurance-based model for a torn rotator cuff in a healthy individual (25-35), the patient will typically need 4-6 months of rehab requiring passive and active PT (~2x per week) according to the US National Library of Medicine. You may also have to worry about meeting your deductible and paying a copay at each visit. If you have a $50 copay for specialty care this might end up costing you up to $2,400 in copays or $3,000 if that’s your individual out-of-network deductible.
In our model, we typically see the patient 1x a week and give them an extensive home program so he or she can begin working on the treatment plan at home. We also see our patient on average 6-10x during a plan of care and quickly go from rehabilitation to working on performance and prevention. Our ten-visit package is $1,800.
At the end of 6 months, cash-based is often more affordable and less of a time investment. This also doesn’t account for the intangibles around enjoying a dynamic, individualized care plan and relationship built with your Kaizen PT.
We totally get it – we want to feel like we utilized the insurance plan we spend thousands of dollars on every year, too. The thing is, health insurance was never intended to pay for our every health concern. It’s insurance – there if we need it in case of catastrophic events.
It’s worth mentioning here that the “cash-based model” is able to accept other forms of payment, including credit/debit cards, checks, and even flexible spending or health savings accounts (if your plan allows it). Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide reimbursement for specialty services received “out of network” (given your deductible has been met). We can help you with this process. Don’t be restricted by your current health insurance policy. Ask questions. Advocate for your healthcare.
Many people seeking cash-based care have high-deductible insurance plans. It makes sense to seek out cash-based providers when your deductible is $3,000 per person or $12,000 per family. You have more options and are able to choose a practitioner that fits your needs and values. Personalized care!
So, why choose Kaizen for your cash-based care?
Unrivaled transparency.
As a patient and valued customer, we feel that you should know exactly what you are paying and what you will get. This means NO surprise bills in the mail months following your visits so you know what to expect before you even walk in the door. No guesswork. No hidden costs. Whether it’s an initial evaluation, follow-up session or anything else we offer, know that you are getting our highest quality care, every hour, no matter what.
As a private, fee-for-service practice, we know that dealing with insurance can take several months for payment, that they can choose their own rates, and that they quickly deny payment whenever possible (after all, that’s how they make money).
This is why Kaizen Health and Wellness chooses (emphasis on this being an intentional decision) a fee-for-service or cash-based model for our practice. In this treatment model, your Kaizen therapist enters into an agreement with YOU to provide physical therapy services in a manner that both parties have decided upon to help you reach your treatment goals most efficiently.
You will pay at the time of service. In our experience, patients who paid ahead for services have been proven to show up to their appointments and work on their program at home. It seems simple but I’ve worked in a model where there was no cost associated with the visits (military healthcare) and our outcomes weren’t always the greatest and no-shows were through the roof. Stay the course, put in the work with Kaizen, and you will reap the benefits.
This model also allows us to focus on providing direct, one-on-one care, while keeping administrative costs low. You may pay for services using actual cash, a check, a credit/debit card, or with your HSA/FSA. In some instances, you may also personally file for reimbursement from your insurance company to curb your out-of-pocket expense. Most insurance companies, with the exception of Medicare, Medicaid and some HMOs, will provide reimbursement for services received “out of network”. We can help you with this process and call your insurance company directly so you know exactly what your benefits look like and what your costs and reimbursement will be.
Our team has all the education, qualifications and accreditations necessary to provide you with best-in-class medical care. For example, our Doctor of Physical Therapy is both residency-trained and board-certified in orthopedics – something you won’t find in many physical therapists, regardless of practice setting. We blend our unique background in strength, conditioning, and human performance to go well beyond rehab and help you live your happiest, healthiest life.
Ready to book your appointment or want to learn more? Book a Discovery Call today with us, and we’ll help you determine your next best step!
