BURNING QUESTIONS WE HEAR the most.
(See? you’re not alone.)
Q: Do you take health insurance?
Yes. We accept any major plan with out-of-network benefits. (Oxford, Aetna, BCBS, United, Cigna) But we are not in-network with any plans. Hang on, don’t jump ship yet! Here’s why...
Q: Why is Clutch PT an out-of-network provider? It’ll be cheaper for me to see someone
in my network.
Glad you asked. It boils down to quality over quantity.
We care very much about the quality of care you receive. Quality care is what will get you better. As an out-of-network provider, we are choosing to see fewer patients in a day in order to ensure an extremely high level of patient care.
Insurance companies don’t look at patient care the same way we do. They put providers like us through the ringer with an application process to become “in-network.” If we’re chosen, we agree to receive significantly less reimbursement for treatments because we’ll be exposed to a bigger pool of patients. But the only way to offset our operational costs is to see more people in a day. A LOT more. That leads to a “patient mill” style of physical therapy that really bums us out, and undermines how we want to treat patients. We just can’t, and won’t, participate in that.
At Clutch PT you will work one-on-one with a skilled, licensed physical therapist who cares about you and what you’re there to accomplish. You will have your therapist’s undivided attention for at least 45 minutes in a private treatment room.
At an in-network clinic, you’ll likely be lined up on a table in an open gym with a bunch of other people while one therapist directs all of you at once. Ultrasound/heat/electric stim/ice may be used as substitutes for individual care and treatment, but those things are just filling your appointment. They might make you feel better for the short term but they won’t solve the root cause of the problem. If you’re only being treated for a few minutes individually, it’s really tough to get better. Your therapist should take the time needed to diagnose the underlying cause of your problem, correct it and make sure you understand how to be your own advocate when you’re not in treatment. That takes expertise and individual attention. That’s why we are out-of-network.
Like parachutes, physical therapy is not something you should get for a bargain basement price. You get what you pay for.
Hopefully that sheds light on the value of being an out-of-network provider. We’d be happy to rant about the specific ways in which insurance companies are squeezing everyone, but our communications guru says we should be “positive,” so we’re holding our tongues. Happy to discuss your own nits to pick with the system when you come in. Fortunately, we’ll have ample one-on-one time to cover that during your treatments, and get to know what else makes you tick.
Q: Crap. I don’t have any out-of-network benefits at all. Now what?
Don’t panic. We want you to get better, so we’ll work with you. We can offer discounts for patients who pay cash up front.
Q: I have an awesome health plan with out-of-network benefits. But I still have a co-pay? How much is this gonna set me back?
Only one way to find out! Before your first visit, we’ll ask you for your insurance plan info and birthdate, and we will find out exactly what your individual plan will cover, and how much your insurance company expects you to pay. (We’re not fans of surprises either, except in the form of baked goods.) Once we know how much you’ll have to chip in, please be prepared to pay in cold, hard cash or by credit card. Bars of gold are alright, but they’re kind of clunky.
*Your insurance company refers to this kind of payment as “co-insurance” — your share of the costs of a covered out-of-network service, generally given as a percentage of the amount paid to the provider. For example, they might cover 60% and you’ll have to pony up 40%. But keep in mind, your payment is also affected by whether you’ve met your annual deductible.
Which leads us to…
Q: What do you mean, I haven’t met my (whopping) deductible yet?
Even if you have health insurance, your deductible is the amount you have pay out-of-pocket each year before your insurance provider covers a dime of your medical costs. (Some plans will cover routine doctor visits and preventive care before you’ve met your deductible, but not always. This is why we will always investigate exactly what your costs are before you come in.) After you pay your deductible in full, you usually only pay only a co-payment or co-insurance for covered services. Unfortunately, your deductible resets every January 1.
As soon as we find that pixie dust, we’ll all be deductible free! Until then, we’ll do what we can to help ease the pain, but we can’t make it magically disappear.
Q: What should I wear to my appointment?
You’ll need to be in comfortable clothes you can move around in. Workout gear is perfect. Your feet will be bare, so, um, please consider that in advance for our sake and yours.
All patients have access to the Bio Fitness gym facility, locker rooms, showers and free towel service. Locks for lockers are provided. Pretty sweet.
Q: Do I need a prescription for physical therapy?
Nope! NY state has “direct access,” which means you can come to Clutch PT for a diagnosis of any musculoskeletal injury without seeing a medical doctor first.* (Woo!) If you need care beyond 10 visits (or 30 days, whichever comes first), then you will need a prescription. But we’ll cross that bridge if we come to it.
To be crystal clear, direct access doesn’t guarantee payment. But that’s why we’ll check your insurance benefits and give you an estimate of what you’ll have to pay before you come in. This is a “financial surprise-free facility.”
* Medicare patients — this doesn’t apply to you. Sorry about that.