Thursday, August 23, 2012

Why You Should See Me for Physical Therapy Rather Than An Office That Accepts Your Insurance

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.


stevenmercer said...

There are a lot of talks regarding the issue but one thing I know and understand is that the companies are there for their benefit as well and they charge for the best care but Physiotherapy North Ryde is also needed to be entered in the stream.

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