How To Save $100's On Health Insurance By Switching To...

Do not worry, this is not an ad for Geico!

This is about going to a Cash-Based Physical Therapy Clinic! Before we go into detail on how this can save you money, lets talk about how much money we are spending. 

Lets say you are a healthy individual. It is most likely that you are NOT using your health insurance on a daily, weekly or sometimes yearly basis. That being said, accidents happen and you have to see someone who can take care of you. Even though you have been paying your monthly premiums, you will end up paying more money based on the amount of services that you may or may not need.  For example, lets say you sprain your ankle. You may have to go to your primary care physican, get an x-ray, get referred to a specalist, get an MRI, possibly more tests and then possibly physical therapy. Based on the type of insurance/physican you have, some of these steps can possibly be taken out, but most often, unneeded services are added. 

Based on the statistics below, you will have to pay a good amount before you are 100% covered by insurance for any healthcare service.

Average Out-Of-Pocket Maximum (Silver Plan) vs. Deductible (Silver Plan)

 

Now the question becomes: what can we do to save money?

2 Words: PHYSICAL THERAPY (PT)


I know, that may be the last thing you expected to hear and yes, I myself am a Physical Therapist. This post is not meant to be biased but to better inform you of your options. Before I tell you about costs, lets talk about what a PT can do.

+ What A Physical Therapist Can Do?

  • PT's receive a Doctorate in Physical Therapy specializing in Anatomy, Medical Screening, physiology, Evidence Based Medicine and Research.

  • Speciailze in musculoskeltal training. As well as in diagnostics and differental diagnosis.

  • Ability to identify red flags and have the ability to refer out.

  • Abiliy to compelte a cardiovascular/pulmonary, integumentary, musculoskeletal, neruromuscular review

  • Restore, maintain and promote optimal wellness, fitness and quality of life

  • Prevent possible injuries and impairments.

  • A study in 2005 noted that Physical Therapists had better knowledge than any other health care professional, other than orthopaedits, in managing musculoskeletal conditions

+ What A Physical Therapist Can't Do?

  • In Texas, we can peform an initial evaluation but can not initiate treatment without a Doctors Referral.

  • Unable to administer or write prescription for medication.

  • We do not perform surgical procedures.


Now lets talk about costs and how you can save. In Texas currently, PT's are allowed to perform an evaluation on you but can not initiate treatment without a Doctor's referral. 

Recently, there have been a growing number of emerging Cash-Based Physical Therapy Clinics that now allow you to come in for a set price for an evaluation and then treatment (upon receiving a referral) bypassing the complications (and glacial pace) of insurance . Although you are going outside of insurance, you can still submit a claim to the company and end up being reimbused for therapy services. 

Lets take the example of two individuals with the same orthopedic injury as above, an ankle sprain and all are under the Silver Healthcare Plan. Now this is pretty specific, but you can apply yourself in this situation too. All values below are based on national averages.

 

PERSON 1

  • This normally healthy patient has the silver plan under the ACA ($361). This patient suffered an ankle sprain and went to their primary care physician ($25), who recommended an x-ray ($15). When the x-ray came back negative they recommended a referral to an orthopedic specialist ($50) who then performed an MRI ($500). It was then determined that Physical Therapy is the best course of action ($200). Total cost in one month: $1151
Person 2

Person 2

  • This patient suffered an ankle sprain and went to a Cash-Based Physical Therapy Clinic for an Evaluation ($200). By peforming specalized tests and measures that are specific to musculoskeletal conditions, it was determined no x-ray or MRI was needed. Based on Texas law, it is required a physicans referral be obtained. The patient goes to the primary care physician and requests a PT Referral ($25). Total Cost in one month: $225
  • Additonal savings can be seen if personally submitting PT claims to the individuals insurance for reimbursement!

wrap up...

The key to saving money on health insurance is to understand all your options, and Physical Therapy has proven to be a safe and effective approach. This blog post focuses on a Cash-Based Physical Therapy Practice. In this system, the patient pays a set price upfront for services and can submit paperwork for reimbursement after. This is a new and innovative approach that can save you even more money than a typical outpatient practice. 

If you want more information or want to book a PT session with the first Cash-Based PT clinic in San Antonio, go to www.omegathlete.com. Join our newsletter and learn more about your options!


 
 

Sources:

1. GoHealthInsurance-age-rating-study.pdf https://www.gohealthinsurance.com/pdf/GoHealthInsurance-Age-Rating-Study.pdf. Accessed 4/15/2017, 2017.

2. Childs J, Et al. A description of physical therapists' knowledge in managing musculoskeletal conditionsBMC Musculoskeletal Disorders. 2005;2017(4/15/2017).

3. Coleman K. 2017 obamacare average premiums and average deductibles - HealthPocket.comhttps://www.healthpocket.com/healthcare-research/infostat/2017-obamacare-premiums-deductibles#.WPKhx9LyuM8. Accessed 4/15/2017, 10-26-16.

Ribu Thomas