“Let me try my insurance first”

4/16/2019

The air is crisp outside and the sun is shining down on you. As you walk down Alki Beach, you can hear birds chirping and people laughing, generally enjoying life. Out of nowhere emerges a huge branch causing you to trip and fall.

Looking down, your ankle is already starting to swell up and throb; you’ve done this before. Once you’ve gotten home safely with a compression wrap, some anti-inflammatory meds, and ice, you start to look for a physical therapist. Luckily for you, Washington State has direct access so you don’t need a referral from your physician. After a cursory review of Yelp and Google, you’ve settled on one close to work so you can go on your lunch break. When calling to schedule your initial evaluation a friendly voice picks up on the other end of the line, proceeding to answer all your questions except for some specific ones regarding your insurance which they’ll go over in person when you arrive to the clinic.

Hopefully you only wait a week or so before you can get in and the receptionist is kind while going over your new patient paperwork. Maybe you’ve already met your deductible and you only have a $10-$50 copay per visit. Or maybe you haven’t and you’ll have to pay out of pocket at first. The information available regarding how much each visit will cost is so nebulous, because honestly even the receptionist or the clinician working with you doesn’t even know. Healthcare in the United States revolves around reimbursement. Clinicians are required to charge abstract ‘codes’ for the types of services they provide which are billed out to insurance that goes through this black box of previously negotiated contracts and discounts, all with the hope that the amount returned to the clinic will cover the cost of overhead and ideally turn some sort of profit.

All of the rules and regulations involved in an insurance-based payment model is at the very least confusing and unfortunately potentially damaging. If you have been to any PT practice, and with an estimated (Statistic about how many people will need physical therapy at least once in their lifetime), you probably have, you’ve seen the impacts of this. Healthcare workers are required to see an improbable number of patients, 15-18 being the standard in an 8-hour work day.  The burnout is felt not only by clinicians but by those they are meant to serve.

Have you ever been to a PT clinic and seen the staff running from one patient to the next or possibly even juggling two or three patients at a time? Have you been handed off to an unlicensed technician after 20-30 minutes with your PT? Or, if you are lucky enough to have one-on-one care from the therapist for the entirety of the session, were they always typing away on their computer while attempting to multi-task during the treatment? This is not a criticism of the altruistic clinicians who are merely trying to care for their patients. This is a criticism of the insurance-based payment model. It truly serves no one.

Healthcare workers get burnt out mentally and physically having to keep up with grueling patient volume and go unpaid for their time spent documenting through their lunch or hours after the clinic closes. And patients get the short end of the stick because the quality of their care goes down and it takes longer for them to get back to the activities they enjoy.

How can we change this? A simple change in perspective could offer incredible opportunities for growth and development. Physical therapy is an incredible profession that enables practitioners to improve someone’s quality of life in immeasurable ways. PTs can utilize their unique knowledge and hands-on manual skillset to educate, exercise, and empower their patients to lead healthier lives. Anyone who has had a successful episode of care with a physical therapist can tell you how profound this impact was on their function and happiness. Sadly, insurance companies devalue our services with no objective rhyme or reason and, to be honest, society isn’t aware of the influence we can have due to our lack of educating the general public. Are you willing to pay $100 for a massage? How about $60 for a mani-pedi with detailed designs your toes? People will happily pay cash for these services because one thing is clear to them: the value. Across the country more folks are shifting to a cash-based payment model and finding that even those with insurance are willing to entertain this idea because they recognize the value of quality care. If you are a provider tired of working in the revolving door model of patient care, or if you are a patient fed up with not getting better, consider a cash-based practice because as with most things in life, you get what you pay for.