Hey guys… Marshall… CORE Therapy & Pilates, so I’m doing a blog about the questions that I get asked most frequently and for me it’s been, “Do you take my insurance?”
The answer I always give is, you know, no but it’s it’s always a positive thing for me because my experience with insurances, I fractured my spine when I was younger like 17-18 and I had to go through the whole PT process. But it kind of sucked because I wasn’t really with the PT for more than maybe ten minutes. Then they kind of just took me and handed me off to an intern (aide or technician) and I did exercises and that’s just kind of how the health system is and how its delegated through the time and how it’s broken up.
But here at CORE it’s completely different and that’s why we can’t really work with your insurance. So having Stephen (or Allyson) you get the full 60 minutes… so if I went in I had 10 minutes with the PT and then spent 50 minutes with the intern as opposed to here I get 60 minutes with Stephen, someone who is very knowledgeable with everything and can help me through all of my ailments… yeah that’s about it… why we don’t take insurance.
I want to add a few things to what Marshall said… We made a choice in 2016 to step away from insurance completely. We went non contracted with all providers after 10+ years of being contracted with 2 in network insurance plans, BCBS and Humana. But what I saw over the years was a steady decline in payments for the in network plans and it started to get really scary as a business owner paying rent and payroll to my staff.
For example, Humana started contracting with a company called OrthoNet to manage the PT visits allowed to their PPO patients. This was a new thing, and a game changer. So the PPO was starting to act like a HMO, allowing just 2-3 visits to PT at a time before needed pre-authorization. So a patient with Humana was paying for 20-25 PT sessions per year in their plan, but OrthoNet was giving out 2-3 sessions at a time. Then would stop approving visits after 7-8 sessions, even though the patient was truly paying for 20-25 per year…
That was just the start, as the other insurance companies started following along and now in Texas, if you do not work for a large company with a big group plan, you are stuck with a HMO… Good luck finding quality PT care in an HMO setting (recall what Marshall described about his experience)… Not to mention the pay from Humana was now about half of what it was just a few years prior. Well, think about it, they had to pay OrthoNet somehow, I guess that came from my fee’s and the amount of visits that were saved and not allowed to the patient in the long run, but that’s another story…
So it was costing more per hour to provide the service than what I was getting paid from Humana. Now if I only had a few Humana patients that week, maybe it wouldn’t be bad, but if my other PT saw 20 of them, ouch I was losing money doing business.
Not everyone understands my decision to go out of network or non contracted with all providers and thats OK… but the clients that have been to those corporate, hospital or doctor owned PT facilities like Marshall described, do get what we offer here at CORE and why… They fill my schedule and tell their friends and loved ones all about us…
The reality is with high deductibles, most people are paying out of pocket for PT services even if they are at an in network, contracted facility or a non contracted, out of network studio like mine…
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