Five Simple Questions You Should Ask Before Seeing a Physical Therapist
Written by Ash Waechter
Before your next appoint with your physical therapist, be sure you know the answers to these five questions that you should know before your next appointment. You will save a lot of aggravation and a lot of money.
1. “How much does it cost to see a physical therapist?”
You want to see a physical therapist, but you don’t know what you should be paying, right? That’s a fair question.
According to Thervo.com, you could pay $20-$55 as your copay with insurance. If you don’t have insurance, you can expect to pay between $75-$180.*
According to Healthcare Bluebook, a fair price for a physical therapy session is $176 for a first-time visit and $120 for a follow-up visit in Fairfield, Connecticut. On the high end, the rates that Health Care Blue Book posts are $264 and $180 respectively.
PLEASE NOTE: While Healthcare Bluebook quotes these numbers as “fair rates,” Manual Therapy Specialists prices are fair below these values. Read on to see why physical therapy at MTS can be far cheaper than most physical therapists.
However, you need to understand how your particular insurance works. You could end up paying more with your insurance plan. Some insurance plans will cover your copay at the time of your physical therapy appointment. However, later on, you may find that your physical therapist will bill for more. This is because your insurance company may not cover all of your physical therapists’ treatments.
As stated by Becky Wesolowski of Restoration Physical Therapy:
“If your plan’s deductible applies to physical therapy, you are responsible for paying the full “contracted rate” for the services provided. Your PT will send a claim for services to your insurer. Your health insurer adjusts the claim, sends it back to the PT, and your PT must then bill you for the adjusted amount.”
Be very careful about paying with your insurance. What you spend on the day of your visit may not be the final payment. When paying through insurance, your physical therapist will have to send a claim to your insurance company. Afterward, you may get an additional bill. So if your physical therapist has it posted that their sessions are $125, be sure to read the fine print.
At Manual Therapy Specialists here in Fairfield, Connecticut, we have one flat fee, so you ONLY pay the amount we give you. Nothing more. No bills sent at a later date for more money.
Many people were caught off guard by these hidden costs of physical therapy.
Here is one such story:
Josh Walton said his physical therapist sent him a bill for $550.33 after he was paying $125 per session for six physical therapy sessions.
When he looked at his bill, he was shocked to see that the average cost for each one-hour session at his physical therapist was actually $525 per session.
Of course, the insurance was covering most of this. However, Walton was very dismayed by the games his physical therapist was playing with him and his insurance company. The physical therapist at the time of his appointment told Walton that “his cost was only $125.” That was true until six weeks later when he got a second bill from his physical therapist.
See below for the actual bill:
Walton said, “I didn’t understand this bill at all. At every appointment, they charged my credit card $125. I thought that’s what the actual physical therapy session costs. I knew that I had a high deductible on my insurance plan, so I knew I was going to pay out of pocket for my physical therapy sessions. But this bill is a total shock to me. I don’t understand it at all. On this bill [Patient Paid] it looks like I paid all sorts of amounts at each session. How am I supposed to comprehend this bill?”
As you can see from Walton’s bill, there are many hidden costs that you don’t know when you make your appointment with your physical therapist. This is the problem when bouncing around between your physical therapist and your insurance company. It’s better to work with a physical therapist who has straight-up transparent pricing.
It’s best to work with a physical therapist that gives you straight up pricing without and hidden fees with the insurance company. Manual Therapy Specialists has precisely that—total transparent pricing.
Make sure you know exactly what you are paying for in advance.
Manual Physical Therapy has total transparent pricing. No hidden fees or costs. The price we tell you at the beginning of your physical therapy appointment is the only price you will pay. There are no hidden fees or other costs associated with your physical therapy appointment.
High costs of physical therapy
Many people are surprised when they get a bill after their physical therapy session. It can come as quite a shock to you if you have experienced this yourself.
Here’s another story about the high cost of physical therapy:
"I had surgery ACL surgery 10/30/12. I have been upfront with the people at PT about not having insurance, and that I'm paying out of pocket, you can imagine my shock to find out I have been billed $342 a session!"
As mentioned earlier, the Healthcare Bluebook puts the high price of physical therapy appointments at $264 per session, so getting a bill for $342 for a physical therapy session can be quite aggravating.
We can assure you that our prices here at Manual Therapists Specialists are way below what we’ve seen so far. To get a transparent and honest cost for your next physical therapy session, click here.
Ask your physical therapist what they charge
Before you set up your physical therapist appointment, ask very clearly how much they charge for your appointment. Whether you are paying with your insurance or not, get a clear answer.
Many doctors—not just physical therapists—are reluctant to tell patients the amount they actually bill to your insurance company. It’s your right to know. Ask them.
You have to watch out what your physical therapist will charge as stated on one online forum:
“I can tell you that while I was working and billing insurance, some paid the full treatment price of close to $230/hour. Yes, PT’s (and other health care prof that bill insurance) do over-charge just to see what the idiot insurance company will reimburse us for. it’s full-on highway robbery."
Manual Therapist Specialists here in Fairfield, Connecticut bills out of network. Read on to see how this arrangement is actually a significant saving for you in the end.
Insurance company adjustments
Your physical therapist may put you at ease by telling you that your insurance company will make an adjustment to your final bill so that you are only paying what they quoted at the beginning of your physical therapy appointment. Buyer beware!
On Blogging Away Debt, Kurt had this to say about the insurance company's "adjustment" for his wife's physical therapy session:
“My wife went to 5 sessions, 45 minutes each, of physical therapy. When we got the bill, it was for $1,600, minus $100 adjustment per their contract with the insurance company. So that comes to $300 per session. We were a little shocked. So far they don’t seem willing to give any kind of price break, even though we have to pay that out of pocket (our insurance has a $3,000 deductible.) Wish we’d have known the price before-hand. We would have said no thanks.”
When dealing with insurance and copays, be mindful of what you are precisely paying at the end of the day. You don’t want to be shocked with a bill down the line. Ask your physical therapist for all associated cost for your physical therapy appointments.
Manual Therapy Specialists has total transparent pricing. The price you are given at the time of your session is the final price you will pay for your physical therapy session.
As mentioned on Thervo.com, “the cost of private pay physical therapy can be 30 to 50 percent less when you pay in cash.” Therefore, paying for your physical therapy session through your insurance may cost you more in the end. Read the fine details of your agreement.
Manual Therapy Specialists handles out of network patients only. As mentioned earlier, this can be a considerable saving for you.
In the end, you can be sure you are the paying the right price at Manual Therapy Specialist because we have total price transparency. At larger clinics that work with insurance companies, patients will often get a bill after the fact.
2. "How long does a physical therapy session last?"
This is an excellent question and needs to be clarified. If you call a physical therapists office, they will tell you that a session will last about an hour. You must be careful about this. Most times, you are in their office doing exercises. However, you are only seeing a physical therapist for about 15-20 minutes. Most of these exercises that you are doing in their facility you can do at home at no extra cost to you. So, if you add it up, you are paying full price for only 1/3 of your physical therapists time.
At Manual Therapist Specialists, you will be with your physical therapist for the entire hour. You will be working with him or her the entire time of your appointment. On a cost basis, this is a better value for your money.
What does this mean for you? More time with your physical therapist (i.e., one hour) equals fewer appointments, you need to make for your full recovery. Less cost for you.
Many physical therapy establishments will have you doing exercises for nearly two-thirds of your total time in their facility. During the first few times, it may be necessary to learn what you are doing. However, after your first one or two sessions at your physical therapist facility, you will know how to do these exercises at home—or even at your local gym.
As far as how many sessions of physical therapy you, it depends on many factors. Some of these include:
· Physical activity level
· Severity of injury
· Duration of injury
The level of recovery you can expect from physical therapy will also depend on how much you adhere to the treatment plan given to you by your physical therapist.
Since our physical therapists spend a full hour with you, you are actually spending less money overall.
3. “Do you need a doctor’s referral to see a physical therapist?”
No, Connecticut is a direct access state. This means you can come to a physical therapy session at Manual Therapy Specials without a referral from your doctor. The one caveat to that rule is that we just need to show improvement in 6 visits or 30 days, whatever comes first.
Be on the lookout for any physical therapy clinic that asks you to see your doctor first for a referral. In Connecticut (and several other states) you don’t need to see a doctor first. However, Connecticut is one state where this rule is conditional.
The condition is that you need to see improvement form your sessions during a certain amount of time. As stated earlier, that amount of time can be six visits or thirty days—whichever comes first. Sounds fair, right?
This could be a sign that you may be paying more than you should.
We’re not saying they are dishonest if they ask for a referral. It’s just that when you need a referral, it usually means insurance is involved. As discussed, getting your insurance company involved can be a sticky situation. It also can be more expensive.