Why cash-pay physical therapy could be the best choice for your knee rehab and return-to-sports goals

Are you an injured athlete and looking for super-focused sports physical therapy but feel frustrated and disappointed when you find out that your favorite option is cash-pay only?

Do you feel like you have to settle for a physical therapy clinic that takes your insurance instead because this seems like the cheapest way to go?

Oof, I feel you. 

As an athlete who’s recovered from four season-ending knee injuries and wanted the best PT possible (but only ones who would take insurance) for the long-haul recoveries that followed, I used to think this way too.

It makes total sense – because when you’re already paying an arm and a leg for a monthly insurance premium, you’d think you’ll get the best deal going through insurance, right?

Having learned from my personal experiences on both the recovery AND provider end, the truth is that insurance-based care can be HIGHLY limiting when it comes to the fast, smooth, and successful recovery you crave deep inside.

Here’s why:

1️⃣ Insurance companies dictate what treatments your physical therapist will be paid for, and the sports-specific training required for a strong and healthy return to sport is often not covered. Why? Because your ability to play your favorite sport is not “medically necessary” according to insurance companies. Their goal is for you to walk again without crutches, get out of a chair, and do the dishes without pain. 

2️⃣ Insurance-based clinics often involve less time getting treatment from your PT and more time going through the motions with a PT assistant or PT aide (so that your PT can make more money by seeing multiple patients each hour).

3️⃣ A full recovery with a safe return back to sport takes at least 9 months and ideally 12 months per research guidelines. Most patients who are recovering from a surgery after a big knee injury run out of visits from their insurance company at about 3 months post-op because these companies only allow 20-30 visits of PT a year. 

4️⃣ BTW, there’s also a deadline for your visits. Let’s say you’re trying to stretch out the amount of time between appointments so you can make sure you can still see your PT for the majority of your recovery. I love what you’re thinking… and there’s also an expiration date on your visits. So if you don’t use them, you could lose them. And should this happen and your PT tries to ask for more, the request might not be approved because the insurance company might decide that PT is no longer “medically necessary.”

5️⃣ When you go through insurance to rehab a big-time knee injury for 9-12 months (which is the research-based criteria for safe return to sport), you’ll end up paying MORE money than you would if you start with a cash-based clinic from the start. Why? Depending on your plan, you’ll likely have to pay the full cost of each visit (usually $240-$300) until your deductible is met (and for most people this is at least $2500.. Maybe even upwards of $10,000). You’ll also have to pay a copay on top of this (usually $25-$100 per visit). Then you’ll have to continue paying a portion of each visit (co-insurance), even after your deductible is met. 

Here’s the math for just 6 months of physical therapy (which is only ⅔ - ½ of the time needed for a full recovery). 

👉🏻 At 1 session a week, you’ll reach 26 visits. 

👉🏻 And if you’re paying $250 for the cost of each visit until your deductible is met, you’ll already be racking up $6,500 in bills just for PT… that’s not including your copays. 

👉🏻 So if you have a copay of $50 per visit, you’re looking at another $1,300 which totals a whopping $7800 (and for just HALF of the care you need in order to make a strong and healthy recovery). This means you’re actually paying somewhere in the ballpark of $300/visit. (p.s. This is DOUBLE of what you would be paying when you work with me).

What this means for you:

1️⃣ Your rehab journey will be cut short by insurance companies well before you even get to the sports-specific part of your recovery.

2️⃣ You’ll feel lost and overlooked in the churn-and-burn of patients that happens in the clinic and you’ll be confused about which exercises to be doing, whether you’re doing them right, and why you’re not getting better.

3️⃣ Not only will your post-op support from your physical therapist be cut short (and by a loooonnnnggg shot), you also won’t get any more help from insurance if you need to go back to PT again for any reason within the calendar year.

4️⃣ Your insurance company is ultimately the only party who decides whether you still need PT or not… without having ever looked at or laid hands on your body during this recovery process (p.s. - most of the time this decision is made by an insurance representative who isn’t even a PT… like a gynecologist or dermatologist). Confused and even more frustrated? Me too.

5️⃣  You’ll inevitably feel up to your eyeballs in financial costs related to this injury, leading to stress, resentment, and ongoing frustration that can actually complicate and lengthen your body’s healing timeline… not to mention the frequent money fights you might have with your partner because unexpected bills are racking up and your bank account keeps going backwards.

So, now knowing the actual truth about how insurance works and what it means for your wallet, peace of mind, and feeling 100% supported all the way through your successful return-to-play recovery experience…

What feels like the better option for you – Settling for an insurance-based clinic or going the cash-pay route instead?

Don’t get me wrong – I do believe that there is a beneficial time and place for the use of health insurance over cash-pay depending on whether or not surgery is involved and the time of year rehab is needed, which are both factors in how fast you’ll meet your deductible and the big-picture financial cost for you. These are certainly factors to consider and definitely something we can make sense of together during a Free Discovery Call if you’re wanting to work with me. You can book one of these here.

At The Knee PT and Coaching, I believe that YOUR voice is the most important in your rehab journey. I also know that you deserve the best care possible without feeling like you have to sacrifice the quality of your experience because of money. 

That’s why my clinic works on a cash-pay system – so that you can get 1:1 undivided attention from an experienced sports physical therapist who knows what it’s like to be an athlete and have big goals for returning to the athletic lifestyle you love. Like you, I believe that these goals are important and necessary for your best quality of life… and they shouldn’t be stopped dead in their tracks because of insurance companies that believe in the same things.

So if you’re wanting the type of recovery that includes:

✅ Top-level treatment strategies that are free from the restrictions of insurance (meaning more soft tissue work, sports-specific neuromuscular retraining, and tools that will help you to get your strength and mobility back faster)

✅ Undivided attention for a whole hour with the same physical therapist throughout your whole journey (no PT assistants or aides)

✅ Confidence and peace of mind that you’ll have access to whatever amount of treatment sessions your body needs to make a full recovery without  limits or deadlines

✅ Certainty about what PT will cost you from Day 1 and the relief that comes when you know you’ll be paying HALF (or less) of what you would be paying if you went through insurance ($150 vs. $300/visit) [monthly payment plans are available to you as well]

✅ A high likelihood of a safer, stronger, and faster return-to-sport with fewer PT visits in the long run

Then I would be absolutely honored to work with you.

🤙🏻 Let’s chat! You can book a FREE Discovery Call here to learn more. 

Sending hugs and cheering you on!

Jen