Why So Many Patients Are Accessing PT WITHOUT Using Their Insurance…

After working as a PT for 17 years, I decided to make a drastic change to my business in January of 2016.

Let’s back up a little first before I finish that thought…

My wife and I opened CORE Therapy & Pilates in Austin in 2005 after moving here in 2004. We quickly built a schedule and were able to start hiring other PT’s and Pilates/Gyrotonic Instructors within the first year of opening our doors. We were in-network with 3 insurance plans (PHCS, BCBS, Humana) and billed out-of-network for any of the other plans. We were super busy on the PT side, which fed the Pilates side as well. I had a 6 week wait to get in for PT with my staff or I, and then had a hard time getting patients in for consistent follow-up visits after their evaluation.

Then insurance started changing rapidly. There were new electronic requirements and the insurance threatened not to pay if I did not comply. These scare tactics did not sit well with me and this is when I realized I was no longer working for my patients, like I used to back in the late 90’s and early 2000’s. Now I was jumping through hoops for insurance and hoping and praying that I would get paid for the service I performed.

So, I decided to make a drastic change to my business and stop taking any insurance, fire my billing service (which was more than my monthly rent), get rid of my electronic documentation system and start writing notes again. Most importantly, I decided to start working for my patients again, NOT their insurance companies.

Let’s Backtrack Once More…

Back when we took insurance, it was typical to have someone call to inquire about PT and the conversation was 100% insurance-driven. We would gather contact information about the patient and then spend around an hour on the phone with their insurance to check their benefits. Then we would call the patient back to discuss these benefits, which was confusing information to most of them.

They would then decide if they wanted to book an appointment based on this information (deductibles, co-pays, co-insurances, etc…).

After a few hours on the phone with a potential patient and insurance, not one thing had been said about the problem, how long it had been there, what had been done so far to help it, nor how the problem limited their daily life? It was ALL FOCUSED ON INSURANCE!!!

Since the start of 2016, when a potential client calls, we spend 20-30 minutes getting to know the person, their issues and their concerns. We do not care about insurance or what they say or think we should do. We focus 110% on the patient and try to determine if we are a good fit for each other first and then move forward.

This has changed the ball game and I wish I would have stopped taking insurance years ago.

Now, I can get a patient in for PT within a day or so from the time they call. I can focus on solving the issues and getting the patient to reach their goals quickly, whether that means returning to golf or tennis, playing with the kids, sitting at the computer or in the car without complaints, or improved activity and mobility. We used to spend 30 minutes at the computer inputting useless information to appease the insurance companies, then doing an evaluation and maybe getting 10 minutes of hands on time. Now, the evaluation takes 10-15 minutes and then the patient gets one-on-one care for another 45-50 minutes during the first session. So, the results come quicker and last longer as the quality of care has risen.

A few quick stories:

I had a patient who sold a business for 100+ million dollars and he was asking me about my switch to cash PT, as he was a patient while I was taking his plan. This discussion happened in early December 2015, just prior to my switch, but after letting all my patients know about the switch that was coming. I knew that he no longer worked for anyone and had to purchase a plan on his own. In Texas, if you do not work for a company that offers a group plan, you can no longer get an individual PPO plan, you must get an HMO. So I asked him to get out his insurance card and let me explain what an HMO is and that even if I still took insurance, I would not take, nor have I ever accepted HMO’s. Out came the card that he had just received in the mail and sure enough, he had an HMO and had no idea. On the card, it showed that his primary care doctor was in Round Rock (about 60’ from his home). I explained that that was the doctor he would have to see before seeing any specialist, getting any imaging orders, etc… and he was dumbfounded. He then said boldly and loudly, “I will just PAY CASH to go where I want!” I said, “Exactly!!!! That’s why I do not take insurance!!!” It was great, because then he totally understood.

My last story is about a patient from earlier this year. A guy came in for a Discovery Session to find out if we were a good fit for each other and if I could help him after his buddy sent him my way. He said he had talked to his regular doctor, who referred him immediately to an orthopedist. In order to schedule with the specialist, he would need an MRI (cost of $1500) first and then he could schedule an appointment in 2 months. My old client had suggested him seeing me first, because for less than the cost of the MRI, I would actually make him better, not just tell him what is wrong. So, this guy asked to be my patient after our meeting and we began implementing a plan. He saw me for 4 PT sessions and my Pilates trainer for 4 weeks. After this, he was 90% better and had spent several hundred dollars less than the MRI, all within 4 weeks. Now, if he would have tried the other route, he would have spent the $1500 on the MRI and still be waiting to get in for an appointment with the Ortho, instead of being back on the golf course playing every weekend. He was the first to say that he wished I took his insurance, but understood why I didn’t and was very thankful for his experience with us at CORE.

Benefits of Cash Physical Therapy at CORE Therapy & Pilates with Stephen Dunn:

  • Patient-driven care, not insurance-driven care.
  • Holistic treatment approach: let’s discuss all of your complaints.
  • One-on-one hands-on care for 30 or 60 minute sessions.
  • Book within a few days; don’t wait months for an appointment.
  • Pilates and Gyrotonic-based PT prepares you to transition to our wellness classes.
  • Treatment packages and payment plans.

Call 512-215-4227 to learn more!

Text us at 512-902-8794

Stephen Dunn