Fee For Service Physical Therapy Clinic In La Jolla
Not In Network With Insurance Providers
At iAM PHYSICAL THERAPY you spend 100% of your visit with a Doctor of Physical Therapy. We are better able to tailor each session to meet your individual needs so that you get better outcomes with longer lasting results!
iAM is committed to providing only the highest quality care and an overall better patient experience to help you achieve your goals and begin living your best life.
For this reason, iAM is a fee-for-service clinic that is not in-network with insurance providers.
Please continue reading to learn how it can actually be cheaper not to use your insurance for services such as physical therapy due to recent changes in healthcare resulting in higher copays or deductibles.
Why choose iAM?
Insurance companies often dictate and strongly influence the treatment that patients receive at insurance based clinics. iAM refuses to compromise your care due to insurance limitations. Not only will you get better faster with longer lasting results at iAM Physical Therapy, but going out of network can often times save you money and time!
Health Care in the US is changing and insurance companies are playing a large role in how physical therapy care is provided to patients. Due to progressively worsening reimbursement rates and other tactics from insurance companies to pay as little as possible on claims (requiring excessive documentation, capping visits, delaying payments, denying payments, and so on), insurance based clinics are not able to provide high-level care AND stay in business. Therapist in these clinics must see 2-4 patients an hour to counter the decrease in payments from insurance companies and overall rising overhead costs needed to adhere to insurance requirements. Your one-on-one time with your therapist is very limited session to session (usually 0-20 minutes). In many cases, your physical therapist won’t even provide manual (hands on) treatment. To make up for this, many clinics hire aides who have no medical background or license to provide much of the actual patient care including modalities with little scientific efficacy (ice, heat, ultrasound) and exercises that could be easily performed at home. Furthermore, with limited one-on one time with your therapist, you'll likely need more visits to overcome your injury (2-3 visits a week)!
iAM Physical Therapy was founded with the goal of inspiring individuality in our clients. This goal ties in with the belief that top-notch care cannot be rushed, limited or capped. Your quality of life should not be dictated by your insurance company. At iAM Physical Therapy, all of our patients receive one-on-one care and manual (hands-on)treatment from a Doctor of Physical Therapy at every session. Each direct-pay visit is 60 minutes (as opposed to the typical 20-30 minute model). Your therapist has the time to fully assess your condition(s), provide hands-on treatment and educate you about your condition and how to overcome it. Knowledge really is power. By having extended time with each patient, iAM is able to provide faster results and better outcomes! What might have taken 12-16 visits in a traditional outpatient clinic only takes 6-8 visits at iAM PT. When you consider the time savings of fewer trips to the clinic and the value of resolving your pain so much faster than average, the out-of-pocket expense at iAM Physical Therapy is a huge bargain
In addition, direct pay treatment sessions at iAM are often times cheaper than what you would pay at an insurance based clinic.
Due to recent changes in healthcare resulting in higher copays or deductibles, It can actually be cheaper not to use your insurance for services such as physical therapy. How is that possible?!
As mentioned before insurance companies are trying to limit how much they pay for physical therapy services. Some insurance plans provide zero coverage or 3-4 sessions at most. Others require high copays of $50/visit or more. If you have not met your high deductible you will be responsible for paying the full bill for your PT sessions until you meet your deductible ranging from $5,000- $10,000. Often these bills are $200+ per session. Under the “standard” medical model, you are treated in blocks of roughly 8-15 minutes, deemed a “unit.” Exercise is a unit, manual therapy is a unit, modalities are a unit, and so on. In a typical 60 minute session (remember 20 minutes with your physical therapist and 40 with the “aide”) 5-6 units can be billed adding up to $200+ for the hour. Now multiply this by 2-3 sessions a week, because you have limited one-one-one time with your therapist. Often times you would even receive the sum total of your bill until treatment is complete (6-8 weeks). By this time, you have racked up an enormous bill of $4,800! This happens every day in every insurance-pay clinic.
Furthermore, your insurance is not applying the full amount of $200+ per session to your deductible! Insurance company will actually pay known as "allowable amount" (typically in the 50% range of the actual bill). A 60-minute session might be between $60-120. Which means only half of that enormous bills ($2400 of $4800) is going towards your deductible.
Before deciding on where to get PT based solely on which clinic “takes your insurance,” make sure you do you research and find out how much you’ll be paying per session at your insurance based clinic versus an out-of-network clinic like iAM…
Most people are quite unaware of the games their insurance companies play in order to pay out as little as possible and maximize their profits. So as you weigh your PT options, it’s very important to:
1. Speak with your insurance company to find out if you have met if your deductible. If you have not met your deductible, ask your prospective insurance based clinic the amount of the average bill sent to insurance companies (aka the PT’s bill not the portion of the bill that insurance as agreed to pay)
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 value you place on high-quality, one on one care from a Doctor of Physical Therapy vs an unskilled “aide.”
4. Consider the time investment that you will have to make, often you’ll be missing work, and time lost with family to attend your PT sessions 2-3x a week.
Do your research, ask the above questions, do the math, and you may be quite surprised at how affordable iAM Physical Therapy is compared to an insurance based clinic.