What does healthcare really cost??

  This morning a potential patient called to cancel her evaluation, because Entropy Physiotherapy is a cash practice, and not covered by her insurance.  It surprises me how much this still stings.  We created Entropy Physiotherapy to provide expert care at an affordable, transparent price.  So I decided to do a little recon work, and see if our efforts to make good care affordable were successful.

I called my insurance company to verify my benefits.  I got through to a representative fairly quickly, but it still took me more than 25 minutes to have him answer 4 simple questions:

• What are my in-network PT benefits?
• What are my out-of-network benefits?
• How do they know if in-network PTs are any good?
• Do I have different deductibles to meet for in and out of network services?

He had to go look up some of the info, but I actually ended up getting a lot of good  answers.  I’ll do all of the math on another post, but the good news is I have coverage to some degree in and out of network, after meeting my deductible.  The bad news is that in-network ($1000) and out-of-network ($2000) deductibles are separate.

For any readers who don’t know, the appropriate deductible needs to be met before the insurance company will pay anything.  So I’d be having $1000 come out of my pocket, even if I stayed in-network.  That’s a hefty chunk of change.  This led me to 2 more questions:

• How does an insurance company choose the physical therapists to send their members to?
• How long will I be in treatment before I meet my deductible?

The nice man at my insurance company could only answer one of those 2 questions.  He said that any provider could go online and fill out the paperwork to become an ‘in-network’ provider.  There is a process, but nowhere is ‘interview’ or ‘review of CV’ listed.  They appear to check and make sure you’re a real person with a license to practice.

I wasn’t’ terribly surprised by this, because Blue Cross Blue Shield of Illinois recently implemented a ‘tier’ system for reimbursement, which currently only applies to private physical therapy practice.   Clinics are arranged into tiers based not on outcomes, or on patient satisfaction, but rather how many visits they saw patients on average.   I’d like to think that my therapist would make the best decision for me for my outcomes.  But the hands of the therapist may be tied by how many visits my insurance would be willing to pay them.

As for the cost of a visit, he had no idea.   He did suggest I see a massage therapist.  And that he thought it was great I running, because it would make my knees stronger, which would help my hips

I decided to find out just what a Physical Therapy evaluation would cost me if I hadn’t met my deductible….

I called 3 different Physical Therapy clinics that were in-network for my insurance.  As a consumer, I’d like to know what I’m paying for any product or service.  As a PT, I’m painfully aware that I’ve had several jobs where I had no idea what my patients were being charged for my services.    So just how much is a Physical Therapy evaluation?  Nobody had any idea.  I was told it would depend on what needed to be done. …  I said just an evaluation….  They still said they didn’t know, but they could guesstimate for me.  Answer from Clinic #1:  $327, but likely I’d only be responsible for $275 after the insurance discount.  Answer from Clinic #2:  $300-$400, but likely only $150 after insurance discount.   Or $114 if I paid cash).  Answer from Clinic #3:  $250-$350, and we should know in about a month what my financial responsibility would actually be.

I’m asking as a Physical Therapist and as a consumer:  Why can’t we find how much a treatment will cost?  There doesn’t seem to be anything else I consume where the price is a complete mystery.   I know how much my dinner is going to cost, as well as how much the bottle of wine will cost.  I know how much my haircut with Ryan is going to cost, and because he’s awesome, I’m willing to pay a little more than I would for a haircut elsewhere.  All very upfront, and I can make my decisions based on what I can afford and what I find value in.  How do we expect patients to accept a randomly selected therapist and sign papers stating that they will be responsible financially for anything that insurance won’t cover (without knowing what services cost, or what insurance will or won’t cover).  In my opinion, we shouldn’t expect anybody to agree to be financially responsible for an unknown amount, and consumers of healthcare shouldn’t accept that ambiguity.