Tuesday, June 9, 2015

Pay for Service vs. Out of Pocket-Could It Really be Cheaper to Pay Cash?

The insurance world is a complicated place and it is only getting worse with the changes now with "Obamacare" (this is not a shot at any insurance program just a statement on its complexity) and all the other options out there.  For a lot of medical services it is a great thing to have insurance to help with the payment of those services.  Need to have surgery?  I know I was glad to have a good insurance plan when I did or else I'd still have a nonfunctioning wrist.  For major life events, preventative medicine (i.e. yearly physicals) and prescription drugs insurance is invaluable but is it always the best option for all of your services?

It's becoming more clear that it isn't always your best option.  We are going to look at a couple models in this post that show it might be more financially beneficial for you to pay cash for services like physical therapy, athletic training, chiropractic, massage therapy and even personal training depending on what is ailing you.

If you injury yourself running or have aches and pains that just don't seem to go away you may go to a doctor* and get checked out and they could refer you to a PT.  Great, insurance can cover that for me and it will help pay the bills....well kind of.

Here is an example:
-Amount for one session physical therapy services: $175.00
-Co-Pay (not counted toward deductible): $25.00
-Deductible (Must be covered by patient before insurance helps): $1000.00 (could be $500 or more)
-Co-Insurance (Percentage patient must pay after deductible is met): 20%

This is a fairly typical insurance set up and the example below doesn't count for if you have paid any other medical expenses during the year that count toward your deductible.

As you can see things get extremely expensive on the insurance side (left side) very quickly before it really helps to kick in at session 7 to even it out.  Most PT's and other medical practitioners would be hoping to have you feeling much better by session 7 (depending on injury).  Here is the final comparison of money.

See the final breakdown of how the money works below:

$760.00 LESS for non-insurance physical therapy services!!  Any ideas of what you could do with that kind of money?

This is obviously just one example in a complicated world of paying for medical services and isn't all encompassing but it gives you something to think about.  There are endless options for who you can see if you're hurting or something just isn't quite right.  Do your research as you're looking around and it might be worth your time to see someone else other the PT at the hospital.  Maybe it is worth the price of that 60 minute massage for your sore quad, knees, or lower legs.  Look for an online service that you can ask the question and they give you ideas of how to fix it yourself (ours is coming soon because it's part of what we believe in, you can fix yourself).

Stay healthy everyone and as always if you have questions or comments, please post or email us at

*Disclaimer: for any major injury always see a physician to have any diagnostics done the rule out major injury.

Vighetti & Associates Sports Physical Therapy Information Sheet

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