Anyone in New York who has received a referral from their
medical doctor for physical therapy can relate to the following scenario: you
have a high co-pay, anywhere from $15 to $50 for someone in-network, or you pay
out-of-pocket until your $2000-$5000 deductible is met and then you’re
responsible for about 30% of the billed charges. You get evaluated and treated
and see your physical therapist for a total one-to-one time of about 5-15
minutes. The rest of the time is spent waiting with a hot or cold pack along
with some electrical stimulation in which an aide sets you up with on whatever
part of the body you are being treated for. And then you spend the rest of the
time doing exercises in their gym being watched by the aide or even a personal
trainer. You’re scheduled for 2-3 times a week of this for about 4-8 weeks.
The Problem
What you may not be aware of is that the physical therapist
has his/her hands tied behind their back as it is the insurance companies that
dictate what they can or cannot do. Health insurance is a business and as a
business, the bottom line is profits. Every year they make it more difficult
for providers to make a decent living as a therapist by 1) lowering
reimbursement rates, 2) denying charges for treatments after a certain period
of time regardless of medical necessity, 3) increasing the patient’s
responsibility with higher co-pays & deductibles/out-of-pocket expenses,
and 4) did I mention lowering reimbursement rates. It’s as if they change their
rules every year and make it difficult for the provider to collect their
charges. Because of this, the therapist has to over-book patients per hour in
order to pay the rent and make a profit. It is common, if not standard, to
schedule 3-6 patients per therapist an hour (I once worked in a local practice
part-time that routinely scheduled me up to 8 patients an hour). As a patient,
you may get annoyed and/or frustrated that your therapist is unable to spend
more time with you and that your treatment is not improving your condition. In
some practices, the patient may see a different therapist each visit. And of
course, that 5-15 minutes with the therapist is because he/she is seeing 3-4
other patients at the same time as you.
For some patients, this is not an issue and they’re
satisfied with this type of care since it works for them. This blog post is for
those that can see through the ridiculousness and can smell the bullshit of the
whole healthcare chaos/mess. As long as the provider is accepting health
insurance within a distorted, profit-driven health-care industry, they are
slaves to the system and slaves to the insurance companies. In other words,
they don’t mind bending over and getting raped by the insurers.
The Solution
Presently, I wear two hats where I work a few days a week in
an insurance-driven medical practice
providing physical therapy, chiropractic, and limited medical services in
Forest Hills, New York and the other two days of the week, I see private,
cash-paying clients in my home office in Howard Beach, New York. I don’t know
how long I will be in Forest Hills, but for now the way I see things is in
order to change the “game”, one must be within the “game” where Forest Hills is
in the heat of the battlefield and I can at least soften the damage of the
casualties of “war” by giving each patient I see the best treatment I can for
the very limited time I am able to see them without getting sucked into the
stress of the crazy “game”. In my home
office, patients pay me $150/hour and get my full Attention and thus get very
significant results that they may have never achieved in an insurance-driven
practice or if they did, would’ve have taken a much longer time (rare). For
most cases, the insurance-driven practice is sufficient, but there is an
alarmingly increasing number of patients with complex situations that medical
doctors and therapists have no idea what to do with them and they’re sent to
one specialist after the other, each with their own referred diagnostic tests
that still tell them nothing that can help them achieve results. Frustrating?
Obviously. Hopeless? No.
I’m not saying I’m a miracle worker but I can truthfully
tell you what I think may be going on with your situation based upon my thorough
initial assessment which I base your treatment program upon where every session
is an assessment & treatment at the same time and not some “one size fits
all” protocol. I am not enslaved by the insurance companies so I will utilize
whatever treatment modality I see fit for your condition. I’ve been doing this
long enough to confidently state that I can help you feel better within 2-5
treatment sessions for the majority of cases where other more complex cases may
take some more time (and commonly, the “simple” cases begin to unravel more
complexities as one receives attentive care). Some cases, such as
post-operative conditions will take several weeks to months – although, much
more functional and effective results than conventional therapy.
The Bottom Line On Why It’s Worth Seeing Me As A Private
Client:
1) Results. And not just any results but Better Results. And
not just Better Results since there is always Hope, the Greater Awareness you
will learn about your body and your “condition”, is quite simply,…Priceless.