10 minute "treatment" $600...WTF? How to avoid surprise healthcare bills.

I often get asked the question “Why are you making the switch to a cash-based practice?”  This is even more baffling since we are leaving our dream situation; a cool home in an outdoorsman’s paradise in the shadows of the Teton’s.  I’ve actually asked myself this question many many times.

But when you believe in something strong enough, sometimes you just have to take that step into the darkness and pursue relentlessly.

What is that “something” that I believe in?  Answer, that there is a better way of providing healthcare then what is common these days.

I am still fresh enough from when I was starting out physical therapy school to remember the quiet excitement and grandiose ideals I had about being a healer and changer of the world I live in.  Then came the reality of the insurance and big provider driven state of our current healthcare system.  Instead of relying on the hard-fought clinical-expertise gained from countless hours of study and practice through my Doctoral training, followed by further breaking down, critique, mentorship, and more practice that an orthopedic residency provided, I found myself expending invaluable time and mental capital writing notes, reports, and figuring out how to word things just right so that the insurance companies would not deny claims.  This time and energy not being given to those entrusted with my care.

I first learned of the cash-based or out of network model of practice in my second semester of PT school.  Initially, it appealed to me due to the fact that I would not have to spend so much time writing session notes.  But as I have studied it further what I have discovered is this whole model is based upon one very important principle, freedom of choice.

Freedom for you the patient to choose your provider…

Freedom for your provider to utilize that expertise they battled to attain, to get you better...

Freedom for you and your provider to collaborate on a plan of treatment suited to you

As you can see from the previous statements there are two key components: You and Freedom.  That is what this whole system is about.

Did you know?  That your healthcare providers who are “in-network” are contracted with that insurance company...

Did you know?  That many/most of the major insurance providers hire third-party companies to review claims (aka your visits); these third-party companies are payed off of commision for the dollars they save the parent insurance company.  Or in other words their job is to find a reason to deny payment for your care...

Did you know?  That many/most insurance providers are a for profit (and even if they claim to be not for profit), meaning their whole purpose is turning profits every quarter...

Did you know?  That in this insurance company-driven model, although your providers have good intentions to provide quality care, they are under the gun to see more people just to keep the doors open.  Hence the reason for the frustration of seeing your physician for the “5 minute” check-up; or with physical therapy to see your therapist for 10 minutes then spend the remainder of your visit hooked up to e-stim or working with an aide...

There is a better way. To contrast let’s take a look at the cash-based model:

Did you know?  That with cash-based model your provider is contracted with you...

Did you know?  That with cash-based model the only person reviewing your case is you, leaving you in control of your care...

Did you know?  That, yes indeed a cash-based clinic wants to make money to keep the doors open...however, if the patient is not getting exceptional care with exceptional results they will just quit coming…

Now onto the story inspiring the title of this post.  The following event (which is 100% true and happened to me) is the catalyst that got High Country Physical Therapy up and running.

This past Spring (2016) our little 2 ½ year old girl had a lingering cold and runny nose.  We were just letting it run its course until the night she was giving me a goodnight kiss when I smelt one of the most putrid smells I have ever experienced (for context I grew up dairy farming and hunting so I’ve experienced some smells in my day).  As we started examining we discovered an object lodged in her nostril.  After multiple failed attempts at extraction we decided we needed to go to the clinic.  My wife Chelsea took her to the clinic where she met with one of the PA’s.  After a quick peek he got a little scoop-like tool.  Chelsea held her wriggling arms and after a few minutes a two inch mucous infected cotton strip was extracted!!  This was exciting, surprising, and disgusting.  That’s a great story Brett, but what does this have to do with this post.  Well we were very surprised 5 weeks later when we received a disgusting $600 bill for this ten minute visit.  Needless to say we were surprised and disgusted by the bill...but more importantly due to my own experience with the broken insurance-driven model that has driven costs to such asinine levels, I’m EXCITED to be introducing HCPT and what we stand for!

Brett

Specialist Physical Therapy Clinic serving Logan and the Cache Valley Area