Here’s why you should be very careful with hospital based physical therapy practices if you have a deductible.

Hospitals negotiate contracts with big insurance companies that allow them to bill at significantly higher rates(2.5-3.5x from our research!) than our small private practice. Now if you simply have a copay then it doesn’t really matter on your end. But as cost sharing shifts more towards patients, deductibles and coinsurance continue to increase. That means that the sticker price for care absolutely matters.

Here’s an example that shows how much money I can spend avoiding hospital based PT:

My yearly deductible is now up to $3000, followed by 15% coinsurance.
At Clinic A, a privately owned clinic, I will owe about $85 per sessionAt Clinic B, a hospital based clinic, which has a contracted rate with Aetna, I would owe roughly $280!
Why would anyone knowingly pay 3.3x the rate of the SAME service?

Here’s another real example.

This looks like 3 separate PT visits and the patient owed $557, that includes part coinsurance. More than $600 would have been owed had the deductible not been met. We will save how I even interpret this bill for another day.

That money is not going to the providers either. It’s going to the administrators. Ever wonder why hospital based systems have 3 front desk people scheduling and answering the phone?

I’m not by any means blaming those that work at these systems. This is just a PSA on how our healthcare system works.

So long story short. Ask about the CONTRACTED rate when at your provider. But believe me when I tell you that it’s very difficult to find out even an estimate of what you might have to pay.

Of course, “the powers that be” DON’T want you to know any of this because it will affect their BOTTOM LINE. But you have rights not only as a patient but as a CONSUMER, and you have a right to know how a service will impact not only your PHYSICAL health but also your FINANCIAL health.

This also applies to other healthcare services. I recently paid over $300 for a 30 minute telehealth dietician appointment for my toddler Alex. A quick google search reveals a much more reasonable $150 max out of pocket cost at an independent clinic. At this point I’m happy to pay cash and skip insurance all together.

This is how the healthcare machine screws us. Hopefully shining some light on this can help solve it.

Ivan Velev, PT,DPT