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.
Quality care is what will get you better, faster. 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 to become “in-network” which means receiving significantly less reimbursement for treatments. 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 doesn’t get people better, 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 Doctor of Physical Therapy who cares about ALL of you and what you’re there to accomplish. We are able to spend the time evaluating your entire body and customizing treatment just for you.
We take pride in doing what’s right for our patients instead of what’s right for a larger corporation or insurance company. At an in-network clinic, you’ll likely be lined up on a table next to 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. You get what you pay for. Other clinics might be cheaper. But they’re also not as good. If cost is what you value most — more so than who treats you or how long it takes to get better — let’s cut to the chase and save each other valuable time: we’re probably aren’t the right provider for you.
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 are firm believers in quality PT for all and we will try our best to find a payment solution that suits both of us.
Your out of pocket cost will depend on quite a few factors. What we can tell you up front is that our expertise will be an investment in your most valuable asset — YOU. The value comes in the fact that we have the experience, skills and passion to get you better faster than elsewhere, with the results and testimonials from patients to back it up.
Q: I have an awesome health plan with out-of-network benefits. But I still have a co-insurance payment? How much is this gonna set me back?
Before your first visit, we’ll ask you for your insurance info and birthdate so we can 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 at the time of service by check, cash, Venmo or credit card.
*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: 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. In most cases, your deductible resets January 1. Some plans are based on the start date of coverage; we’ll help you determine when yours resets.
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: I really don’t have time to come to PT. How many sessions will I need before I feel better?
We get it — you have a lot going on. But we can’t answer that question definitively until you come in for your initial evaluation. We will get you in ASAP, and offer early morning and late evening appointments to accommodate your schedule. We are also really good at what we do and assure you we will get you back to doing whatever it is you love as soon as safely possible.
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. You will need a prescription from your referring provider before your eval in order for us to submit claims to Medicare on your behalf.
Q: What should I wear to my appointment?
Wear comfortable clothes you can move around in. Workout gear is perfect. Keep in mind we’ll need access to the part of you that hurts, so dress accordingly. Capris, leggings or tri shorts are all good choices. Your feet will likely be bare too, so, um, please consider that for our sake and yours. Please arrive ready to roll, or come early enough to change in the locker room. We don’t want to waste any of your treatment time on wardrobe changes.
Right now, patients only have access to the restrooms and treatment room, not the locker rooms or showers. We hope you understand.