Why Don’t You Take Insurance?

I know first hand the games insurance companies play in order to pay out as little as possible and maximize their profits. How? I spent years working for a large, nationwide health insurance company helping write their Clinical Practice Guidelines (evidence based policies on how to rehabilitate injuries and diseases) as well as their utilization management policies. These are the structures for pre-approval of visits and whether services are covered by your insurance. After several failed attempts to get them to stay with a clinically based decision process, they decided to go another direction which I did not agree with. 

Due to progressively worsening reimbursement rates and pressure from insurance companies, the therapists at in-network clinics have to see at least 2 patients per hour (usually many more) and they often use technicians and assistants to provide much of the actual patient care. The care often includes modalities like heat packs, electrical stimulation and ultrasound, and the majority of a patient’s time at the clinic is spent doing exercises they could do on their own time or waiting for someone to tell them what to do next. Furthermore, these types of clinics tend to require patients to attend 2-3 appointments per week. This is not a knock on any therapists at these clinics. It is the reality of the business model.

Insurance companies often dictate or strongly influence the treatment that patients receive at “in-network” clinics. Unfortunately most, and soon all, private insurances will operate this way. Sadly, they do not have your best health care interests in mind.

QLife is an out-of-network practice because the in-network practice model rarely allows for the high-level care my patients deserve.

Why is the level of care at QLife PT better?

Personalized Attention: I have a smaller patient load, which allows me to dedicate more time and attention to each individual. All of my patients receive one-on-one care and hands-on treatment from a me in every session. This results in more personalized and focused treatments tailored specifically to your needs.

Treatment Flexibility: Insurance-based physical therapists often face limitations imposed by insurance companies, such as treatment duration and approved modalities. I have greater flexibility in choosing the most effective treatment methods and techniques for your condition without being bound by insurance restrictions.

Longer Treatment Sessions: Insurance-based physical therapy clinics are often constrained by billing requirements, which can limit the duration of each session. Here, I can provide longer treatment sessions, enabling more thorough evaluations, hands-on interventions, and comprehensive care.

Enhanced Continuity of Care: I am involved throughout the entire treatment process. I have the ability to closely monitor your progress, make necessary adjustments to your treatment plan, and ensure a seamless continuum of care. This level of continuity can result in better outcomes and a faster recovery.

Increased Therapist-Patient Collaboration: In a cash-based model, you have more direct access to your physical therapist, fostering a stronger therapeutic relationship. This collaborative partnership empowers you to actively participate in your own recovery, ask questions, and receive ongoing guidance and education about your condition. I am always just a call, text, or email away, even on weekends.

Reduced Administrative Hassles: Insurance-based physical therapy often involves complex billing processes, paperwork, and pre-authorization requirements. Without these administrative hassles, you are allowed to focus on your recovery rather than dealing with insurance-related issues and delays.

Comprehensive Services: QLife offers a wider range of services beyond traditional physical therapy, such as wellness programs, fitness training, and preventive care. This holistic approach can benefit your overall health and well-being beyond the scope of your initial condition.

Value for Money: While cash-based therapy may initially seem more expensive, it's essential to consider the value you receive. With more personalized attention, longer sessions, and enhanced outcomes, the investment in cash-based therapy can ultimately lead to fewer overall sessions and a faster recovery, potentially offsetting the higher upfront costs.

Why Wouldn’t I Use My Insurance?

On top of the higher level of personal care, the out-of-pocket expense for my treatment sessions is sometimes less than a patient would pay at a clinic that accepts and bills their insurance.

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.” 

Make sure you know how much you’ll be paying at your in-network options versus an out-of-network clinic like mine.

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 accumulated a huge total bill!

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 may charge. Meaning, you’ll never meet your in-network deductible unless you are there multiple times a week for months.

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 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.

* 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. This is another game from the insurance companies to discourage competition and avoid paying claims.

What Conditions Does QLife Treat?

QLife Physical Therapy effectively treats all orthopedic (muscle, tendon, joint) conditions including post-surgical cases. In addition to being an Orthopedic Specialist, Andrew has trained in vestibular and concussion conditions. High functioning progressive muscular disorders are also treated here.

My success stories include patients dealing with everything from headaches and neck pain to bunions and ankle sprains; from knee, hip and low back pain to rotator cuff tears, wrist, hand and tennis elbow. Golfers, runners, Spartan athletes, or just weekend warriors have all recovered from, or avoided injuries and surgeries by working here at QLife.

Am I a Good Fit for QLife?

Many of QLife’s clients are folks who have been through the endless wheel of referrals, waiting, rescheduling, and poor outcomes and have found the personal attention and level of care they have been seeking for years.

You are a great fit if you have an injury or pain that is keeping you from staying active and living well, you want the highest quality, one-on-one care and usually don’t have the time to go to a clinic 2-3 times a week for 2 months or more.

QLife patients want to be highly active and are motivated to move, look, and feel their best. Staying that way is very important to them and they also place a high value on their time and money. Andrew is equally comfortable working with your teenager as he is with your grandmother. It is never too early and never too late to make a difference in one’s health.

What should I expect during my first evaluation?

It is very important that we obtain your full medical history and a thorough understanding of how your symptoms or limitations are affecting your life.  A fair amount of time will be spent listening to how you have addressed or managed your condition already, i.e. what’s worked and what’s been a waste of time.  From there we can we figure out how we are going to change things for the better.

After learning your health history, we will do a comprehensive physical examination.  This is when we start to map out where your restrictions in movement or weaknesses are. Once we cover all the appropriate phases of the examination, we can start putting the pieces together and come up short term goals that build toward a solution to your long term goals. Generally you will have to achieve each short term goal in order to properly fix whatever your issues may be.  No short cuts.  Short cuts lead to recurring, nagging injuries.  Let's spend the time to correctly figure it out.  

Please don't let past failures at other physical therapy clinics deter you from finding answers.  You have my word that your goal is my goal- to make you move and perform your best. 

So be prepared to move during your evaluation and dress accordingly.  The initial evaluation will take 90 minutes.