Do You Take My Insurance

When a new patient or potential new patient calls your physical therapy clinic and the first question he asks is “Do you take my insurnace?” we need to understand that the question isn’t really about insurance.

He is saying “I need to know how much this is going to cost before I agree to it.”

This means either your marketing efforts failed to provide this prospective new physical therapy client with the information he needed AND he isn’t yet in a situation in which his problem is bigger than the cost of a solution. 

Do You Take My Insurance?

Let’s break this down into a couple translations:

1.) How much is this going to cost?

My personal frustration with healthcare is the lack of price transparency. If I am the patient, I want to know the cost of the service before I agree to receive the service.

Often neither the provider nor the insurance company is able to provide me with an exact price I will be expected to pay.

This makes it impossible for me to make a decision and as a result clients tend to default to and answer of “no.”

Whether you are in network, out of network, or cash pay, you should have a price guarantee that you can quote before rendering services.

“Mr. Patient, the most your first visit will cost you is $150. If your insurance pays all or some of that cost we will immediately refund you the difference.”

Now, that client has an opportunity to make a decision.

After that first visit, you should be able to provide a couple treatment options for price sensitive clients. Each option should again include a maximum out of pocket cost provided in writing.

2.) Is this solution less painful than my problem?

Another translation of the question “Do you take my insurance?” is “Is this solution less painful than my problem?”

For some prospective new patients, a $150 bill is more painful than the shoulder pain keeping them up at night.

I often speak with patients who would like to resolve their shoulder pain and would consider physical therapy as a possible solution, IF it only took one or two sessions AND it didn’t require any inconvenience, cost, or lifestyle change.

Since we know that is rarely the case, the real question being asked is “Is the pain of paying for and doing physical therapy more or less than just accepting the pain or limitations I currently experience?”

3.) Is there a better solution?

A third interpretation of the question “Do you take my insurance?” is “Is there a better solutions to my problem?”

Many prospective clients might accept that attending physical therapy is one option to resolve their problem, but what if there is a better option? What if there is an easier option? What if there is a less expensive option?

Nobody likes to feel stupid. If I buy an apple today and tomorrow I walk in and see the same kind of apple on sale for 50% off, I feel like I made a bad choice. I feel like I should have waited.

Even if the apples are slightly older and slightly less fresh.

Paying a higher rate might be enough to make your prospective new patient feel like he made a bad choice.

Best answer to the question “Do you take my insurance?”

“Absolutely, but first let me collect your insurance information and some information about your condition. Then let’s get you scheduled and before your appointment I will verify your insurance coverage and let you know exactly what the cost will be if any.”

When the prospective new pateint has no Out of Network Coverage?

After you have collected the pertinant case history and verified insurance coverage, you have enough information to offer the patient several options.

For example, in some cases the patient may have a $35 copay when going to an in-network provider. If you operate a brick and mortar clinic and believe that this patient may only require a single unit of therapy per visit, the true out of pocket cost is identicle for coming to you vs going to an in-network provider. The bonus is since the pateint is choosing a self pay option seeing you, they are able to “conserve” their physical therapy benefits if they should need additional therapy later in the calendar year.

A second example may be a patient that has already undergone surgery and has met his out of pocket maximum for the year. If this patient has in network and out of network coverage the out of pocket cost to the patient might be identical regardless of seeing an in or out of network provider.

A third option is to deliver the initial evaluation and plan of care as a self pay service, then have your patient receive follow up care at an in-network provider.