When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at Optimize is a huge bargain.
On top of that, the out-of-pocket expense for our treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.
How is that possible?!
As deductibles and PT copays have skyrocketed in recent years, many of our patients who have high PT copays or have not met their deductible pay less out of pocket for our treatments than they would if they went to a clinic that “takes their insurance.”
So before deciding on where to get PT based solely on which clinics “take your insurance,” make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like ours…
These days, some insurance plans provide zero coverage for PT visits or require copays of over $50/visit. And if you have a deductible to meet, you’ll likely end up paying the full bill for your PT sessions until you meet the deductible (and these bills are often $200+ per session). However, you usually won’t start receiving those $200+ bills until after you’ve been getting care for 6-8 weeks and have racked up an enormous total balance (again, often being asked to attend PT 2-3 times per week).
And guess what else…just because you’re paying $200+ per session at a clinic that is in-network with your insurance, does not mean that your insurance is applying that full amount towards your deductible! They often only apply the amount that they have agreed is reasonable for your PT sessions which is, of course, far less than the amount the PT clinic actually charges.
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
1. Inquire with your insurance company about what percentage of the total PT bill you will be required to pay at an in-network clinic (especially if you still have a deductible to meet).
If you will be paying 100% of the bill till you’ve met your deductible, ask the prospective PT clinic the amount of the average bill sent to an insurance company (the PT clinic’s amount on the bill … NOT what the insurance company has agreed they will pay the clinic). In most cases, you will ultimately be paying the full bill until your deductible is met.
2. If you have met your deductible, ask how much your copays will be? Ask how many times per week the average patient is asked to come in for treatment.
3. Consider the quality of care you’ll be receiving at your various options, and how much value you place on receiving higher-quality, one-on-one care from a Doctor of Physical Therapy rather than a PT Assistant (PTA) or an unskilled “Tech.”
4. Consider how often you’ll be missing work and/or time with family to attend your PT sessions. Again, you can ask any prospective clinic how many times per week their average patient is asked to come in for treatment.
Ask the above questions, do the math, and you may be quite surprised at what you find!
*One other thing to consider is whether or not you have just one deductible or if you have both an in-network deductible and an out-of-network deductible. If you have two deductibles, then claims from an out-of-network clinic like ours will not apply to your in-network deductible.
With all the above information, you can now get a real sense of what your true costs will be, what level of care you’ll be getting, and then make the best decision on where to receive your physical therapy treatment.