The Advantages of the Private Pay Model for Physical Therapy

One of the biggest political issues over the past year has been health insurance and what is going to happen to the Affordable Care Act. Between the election and various Supreme Court cases, the future of “Obamacare” was in question for much of 2020, causing many people to look at their health insurance options. Now that the results of the election are finalized, it appears likely that the Affordable Care Act will continue to exist—a fact that some people are happy about and others are frustrated by. But regardless of your opinion on the ACA, it is important to note that there is another option when it comes to physical therapy and rehabilitation—the private pay model.

While it is often appealing to allow your insurance carrier to deal with and cover medical costs, the reality is that using insurance often comes with a few disadvantages, particularly in relation to physical therapy for stroke victims and spinal cord injuries. For instance, while insurance pays for some treatments and exercises, there are many that it does not cover. What is covered under most insurance policies is typically standardized for the purpose of medical coding, but the care needed by different patients is anything but standard. Because each patient is a unique individual with a unique medical history, it is important to customize physical therapy treatments so that they are targeted specifically at the patients’ needs. This enables the therapist to address specific issues most effectively, and helps patients to reach maximum recovery benefit as quickly as possible.

Another issue with insurance is that therapists have to spend a few minutes billing insurance companies in order to get paid, which typically cuts into time spent with patients. When adopting a private pay model, patients get fully customized treatment plans and the full hour (or longer!) with their therapists, with no time sacrificed for paperwork and other concerns. This is particularly important for patients dealing with spinal cord injuries and stroke symptoms, which often take time to rehabilitate.

In the same vein, most insurance companies only pay for a handful of therapy sessions per year, unless therapists can get additional sessions approved (which is often quite difficult to accomplish). Private pay patients have no limit to the number of therapy sessions per year, which means they can work with their therapists until their conditions are completely and satisfactorily resolved. Some patients even opt to continue working with their therapists once their symptoms have improved in order to establish proactive strength and fitness practices that help to prevent future injuries.

A final benefit of the private pay model is that patients are more motivated to work hard during the rehabilitation process. Often, when therapy is being paid for by someone else (such as an insurance provider), we tend to value the therapy less and invest less energy into our own healing. When we are invested financially through a self-pay program, this provides additional motivation to overcome our injuries and disabilities, and helps us commit ourselves to the healing process.

While insurance providers can be helpful when facing the enormous costs of catastrophic illnesses and injuries, there is also a clear benefit to pursuing physical therapy and rehab through a private pay model. Whichever model you decide to use, the most important thing is to get started on your rehabilitation as soon as possible. The sooner you start working with the therapist, the sooner you will begin the rehab process and begin the journey toward healing.