Investing in your Health(care)
Why would I pay cash when I could use my insurance somewhere else?
As I entered into a cash based practice, I had a crazy realization. The way we shop for healthcare is extremely interesting when you think about it. Most of us just simply don’t shop around or, when it comes down to it, the market is not conducive to shopping around.
It feels like the system is overloaded, but we continue to place growing demands on it. For example, my mom recently was looking to establish a new primary care provider. She had to call five clinics before she found a provider that was even accepting new patients. Once you establish that relationship with a primary care provider, referrals typically stay within that health plan – regardless of wait time. Doctors are either told where to refer patients (most times in house if available) or a referral coordinator is handling it completely. The patient truly has to speak up and request to go somewhere outside of the system if they have a preference. All in all this process leads to a very passive consumption of healthcare. Patients are waiting weeks or even months to get into a specialist and by that time, the problem they came in for is almost unrecognizable from the time of the complaint (typically not for the better).
So I started to wonder: why do we accept this in healthcare when we would never accept it in other services?
Part of this big realization I had is in relation to how I personally select other services. I currently drive 2 hours to Nashville to get my hair done. I met my hairstylist in high school because she had worked with several of my family members who all loved her personality as much as her skill set. Once I found someone who I liked and trusted, she is well worth the commute. If I did choose to go elsewhere, I would not just pick the place in closest proximity to my apartment. We’ve all had a bad hair experience at some point y’all and you know it’s worth reading some reviews or at least getting a referral from a friend (with good hair).
Maybe you can’t resonate with the hairstylist commute, but I’m sure you don’t trust just anyone to come do work inside your home. You get a recommendation from someone who has had a positive experience or comb through reviews on google trying to find someone you can trust. We are extremely tough critics on many of the services we seek out, but with healthcare, we have become accustomed to leaving it in the hands of our primary care provider or our insurance company’s network. People believe: “this is where my doctor sent me, so I HAVE to go”. The funny thing is, like I mentioned before, your doctor probably has no clue about the quality of therapy delivered by the place on your referral. I worked at three private practices in four years and can count the amount of providers I have had quality face time with on one hand. Everyone is just simply becoming too busy to assure that when you walk out of their door, it’s in the right direction.
When you compare healthcare to other services, it sounds crazy that we don’t take more or an active role, right? Especially when you think about pelvic PT and the level of privacy and sometimes trauma that is involved in that process. Somehow with our doctors, the people we rely on to know the most personal details of our health and to make decisions regarding keeping us safe and healthy, we just roll the dice. I get it, though, and if you do this, you are not alone. It’s a little cringy to think about not using your insurance whenever possible since those opportunities seem to rarely arise and we feel like we dump so much money into our benefits. The unfortunate thing about using our health insurance is that we run into two major issues: lack of transparency on pricing and coverage limitations. You may never know the clear price and you may not be guaranteed the quality of care you desire as clinics become higher volume and coverage continually declining.
Let’s go over two scenarios that happened quite frequently in my time working for a traditional PT practice that highlight these issues:
Kim is an avid walker and her social / sanity time is being able to walk with her friend at night to debrief from the day. After dealing with plantar fasciitis for 6 months, Kim finally can’t stand it anymore and is excited to arrive for her initial evaluation. Kim has a popular commercial insurance plan. She knows that it includes PT coverage, but like most people, Kim does not fully understand her benefits. She goes through her initial appointment and feels optimistic about her plan…until she hears her coverage. Kim owes $100/visit and a percentage of each visit. When she asks what that percentage is, there is no clear answer because it depends on several factors. There’s no clear answer to give her. So Kim’s visit is $100 + ? and she feels deflated and uncomfortable moving forward without having a clear understanding of the potential cost. She doesn’t come back for additional visits.
John also has a commercial insurance plan that has a cheaper copay than Kim, but has a visit limit of 20 visits / year. He is post rotator cuff repair and cannot actively use his arm or begin strengthening until 12 weeks after surgery. Without early intervention, John is at risk of frozen shoulder and losing his mobility because of stiffness in the joint without someone to stretch it out. John wants to use his insurance, so he has to space out his visits as much as possible, against recommendations, to make sure he can get back to his life without long term issues. Once he hits the 20th visit which lands soon after he has begun his strengthening program, his care is complete and he cannot be seen for anything the rest of the year unless he pays out of pocket. It’s only May.
These examples highlight the lack of transparency around coverage and how insurance plans do not cater to an individual’s needs at all. They don’t care if your surgery protocol requires closer to 36 visits for an optimal outcome. They don’t care if you’ve had pain for 6 years and it’s simply not going to be solved in 6 weeks. It’s simply not always advantageous for both your wallet and returning fully back to the quality of life you seek.
I started a cash based practice because I was extremely frustrated by this insurance game. I went from seeing patients one on one in my first year of practice to the expectation continually growing from a minimum of two an hour to an expectation of three patients an hour. I didn’t see an end in sight and I already knew that my focus was lacking, I was losing some of my compassion and I wanted better for my patients. I realized that guaranteed quality lies in more time with patients – whether that be longer sessions or prolonged plans of care that allow for full goal accomplishment instead of only symptom resolution.
When you take the time to shop around and find a good fit for your situation, you are investing in that journey. You are prioritizing yourself and committing to achieving that goal. When someone chooses to work with me, they have my complete focus, support, mutual accountability and a mind that is devoted to helping them fully solve their problem – as long as it takes. The only surprise is how good you’ll feel, not the bill in the mail.