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  • Writer's pictureDr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic

Everything You Need to Know About Private Pay Physical Therapy

  • Is Physical Therapy covered by insurance?

  • How much is Physical Therapy if I pay out of pocket?

  • Why are some physical therapy clinics cash based?

  • Doesn’t it make more sense to stay in-network?


If you have found yourself asking these questions, then this blog is for you.


When choosing which Physical Therapy clinic is the right fit for you, there are many factors that need to be considered. 


And yes, the first tangent has begun, the clinic where you choose to seek PT treatment is your choice, not the referring provider’s choice. So even if they give you the name of a clinic (which they may even have ownership in), you can still do your own research and select the clinic that you resonate with - but I digress.


Back to the point at hand, when patients make the decision to begin PT, many patients ask the following deep and thoughtful questions:


  • Do I see the same Therapist each session?

  • Does the Physical Therapist have more than 1 patient at the same time?

  • Is the physical therapist recognized as a specialist? 

  • Do they have experience with my condition?


And these are great questions that every patient should ask when interviewing or researching PT clinics. 


But many patients ask surface level questions, such as:


  • Which physical therapy clinic is covered by my insurance?

  • Is this clinic in-network?

  • Is this clinic located the closest to my house/office?


And while these questions seem to be the most pressing, they will never correspond with the quality of care you will receive at the clinic.


For example, just because a clinic is “in-network” with your healthcare insurance, does not at all imply that the quality of care will exceed expectations. 


What this almost always guarantees is that the treating Physical Therapist will have multiple patients at one time - thus limiting the PT’s availability to your session. You will likely spend less than 30 minutes, and sometimes less than 15 minutes, of one-on-one time with your Physical Therapist. 


In the insurance-driven clinic model, PTs have high productivity standards, leading to burnt out PT’s looking to move on to the next patient and ultimately clock out for the day. 


Additionally, when you are working with an insurance clinic, you will be told you need to be treated 2 or 3 times per week to maximize the effectiveness of the treatments. Meanwhile, depending on your insurance “benefits,” you may have as high as $50-$100 co-pays per session. And since in-network PT clinics routinely see patients for 12-36 total treatment sessions throughout the plan of care, this can become quite costly AND inefficient. 


Not to mention, many insurance plans have co-insurances/deductibles built in and bill the patient at a later date. This unexpected bill is then received a few months later by the patient for $1000’s of dollars and is known as surprise billing. 


So what do I do? What is the alternative to an In Network Physical Therapy Clinic?


But what if I told you, there is a way to avoid this. What if I told you, there is a model of Physical Therapy that addresses a different set of questions. Questions that are centered around the patient, and not around insurance “benefits.”


This new and improved healthcare model focuses on what the patient needs (rather than what the insurance will pay for). And this model that focuses on delivering efficient results is sometimes referred to as Private Pay Physical Therapy, Cash Pay Physical Therapy, Cash Based Physical Therapy, or, as we prefer, Out of Network Physical Therapy Services.


And the many reasons that this model delivers far superior results are:


  • The Physical Therapist will spend 1+ hour of one-on-one care with you at each session. 

  • Due to increased attention to detail at each session, you will likely only need to attend sessions 1x/week and significantly less overall sessions. 

  • Your Physical Therapist will not be confined to insurance barriers such as

  • Your insurance only covers PT for “shoulder pain” so the provider can’t address your mid back/neck (which is almost always involved and NEEDS to be addressed).

  • Not being able to perform needed treatments, such as dry needling, because your insurance doesn’t cover it.

  • Your Physical Therapist will likely be a specialist and deliver specialist services, which are, at times, not covered by insurance.


But why does this matter?


Yes, when first learning about private pay Physical Therapy clinics, it may initially seem a little backwards. You may ask yourself, why would I pay for Physical Therapy out of pocket, when I pay a premium for insurance every month. 


But if you do a little digging, and look closely at the pros and cons or the 2 models, you will find the answer is that when you see a specialist who is able to spend 1 hour of one-on-one care with you at each session, the final and total investment will likely be much lower than trying to stay in-network. Additionally, the level of communication present between the patient and provider in an out-of-network model is unmatched when attempting to work within the confines of the network. 


We, at Flow Physical Therapy and Wellness in The Woodlands, Texas, have two Doctors of Physical Therapy with specialty credentialing and/or certifications. Dr. Patrick is a Board Certified Orthopedic Clinical Specialist, Osteopractic Physical Therapist, as well as being Fellowship trained by the American Academy of Manipulative Therapy, and Dr. Melissa is our Pelvic Floor/Women’s Health Specialist, as well as having earned her credential as a FAMM Practitioner (Fertility Physical Therapy). 


Simply put: 


Flow Physical Therapy and Wellness is a Private Pay Physical Therapy clinic in order to provide the highest quality care in the most efficient and patient-centered manner. This model allows for genuine financial transparency and empowers the patient to remain in control of healthcare/treatment expenses throughout - no degree in insurance jargon required. 


So if you are ready to schedule a free call and learn more about the new era of Out of Network Physical Therapy services, click the button below and let’s begin the conversation. 


Dr. Patrick Thompson, PT, DPT, OCS, Dip. Osteopractic

Owner of Flow Physical Therapy and Wellness

832.299.5447

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