There is an experience that countless people share across our country. It is happening with increasing frequency, and today, it happened to me.
Today, my son’s speech therapist informed me that from now to the end of the year, our insurance will only cover 10 more visits. Although, medically necessary to receive speech 2-3x/ week based on his evaluation he is only given a total of 30 visits/per year. Now I am forced to decide: do I scale back the frequency of his appointments to once a week for 10 weeks? Or, for the sake of consistency and repetition, do I continue twice a week for just 5 more weeks?
Regardless, unless I pay-out-of-pocket he will be without therapy for months! I got a sinking feeling in my gut when I got this news. Our son had just started making progress! Without continual and proper intervention, that progress will stall (at best) and likely – to a degree – be lost.
What if there was a better alternative?
- What if you – the parent – dictated your child’s care rather than a third-party insurance company?
- What if you were able to have more high-quality treatments because insurance and the red-tape were not dictating your therapists’ time, energy, and availability to put thought and quality time into each of your child’s sessions?
- What if insurance did not dictate what services your child would or would not qualify for?
- What if YOU and your child’s therapist collaborated TOGETHER to identify the areas needed for intervention regardless of diagnoses, etc?
Imagine your child’s therapist working alongside you – partnering with you – instead of some third-party payer who doesn’t really know your child and their needs?
Benefits of the cash-based model
- Below is a small graph that shows that out-of-pocket costs are on the rise and consumers are required to payer higher deductibles. With this in mind, maybe it is time to consider the added benefits of self-pay?
Looking at these graphs maybe your question changes from “Do you take my health insurance?” to “Who do I trust to provide me with the best quality for my money?” This is when a cash-based model may be beneficial to you. Below are more reasons you may benefit.
- Cost effective care- Therapists are highly trained and skilled for their field. If you already have a high deductible then it is worth paying cash for thorough evaluations and treatments.
- Accessibility- Anyone insured or not is able to come to my practice. Also, because cash-pay practices tend to have fewer clients you can be seen sooner than a typical practice and the sooner you can be seen the better! In addition, I will even say, “hello” to you and get to know you rather than just asking for your insurance card and handing you a stack of papers to fill out.
- No hidden fees- A cash-based practice will be able to tell you exactly what you owe rather than sending forms into insurance and wondering what they will actually cover. However, you will be provided with a superbill and can submit it to your insurance company for possible reimbursement (check with your provider on how this works with your individual plan). In addition, because we are not submitting to insurance we do not charge you for that administrative cost. You are paying ONLY for the therapy services being received!
Benefits for the Therapist:
- Freedom to provide services I see are most beneficial and not restrained by red-tape of insurance companies
- Less burnout because I will not be spending hours on the phone with insurance companies trying to get services provided for you that are medically necessary. At the same time, making sure I am getting paid by them for my services. In addition there is the headache and stress of trying to keep up with their ever-changing regulations.
- Focus is more on quality than quantity. Often times, therapists can feel like they are factory workers seeing clients for 30 minutes back to back. If you don’t have breaks between clients when can you think through treating the next person? With children, especially, they often need at least an hour for therapy for it to be beneficial. Often times, they need to get their sensory systems organized before they can start on other smaller tasks such as fine motor activities etc.
I hope you find this post educational as more and more therapy offices, specialists, and primary care physicians are heading in this direction! Please reach out if you have any questions.