I don't need to cite a bunch of facts for you to know that health care costs are rising. I certainly have some shocking statistics to throw out there though, if you want to hear them.
What it costs to be insured goes up every year. I just got my friendly notice from Blue Cross Blue Shield stating that my premium would increase $50 per month in 2016. My benefits, however, would be staying the same. This was the third year in a row that I received such a notice, and I'm sure many of you were sent the same letter; we are in the majority.
The penalty for NOT being insured is also rising, as is the price of any sort of medical care. All of these costs are increasing much faster than the inflation rate (almost 6% for healthcare verse between 0-2% for general inflation in 2015). My personal insurance plan will rise by 18% just this year! In 2024, healthcare will account for 1/5th of our gross domestic product. I said I wouldn't cite statistics. Sorry for lying.
Knowing that cost are rising, that service is staying the same, and that overall markers of American health are getting WORSE... What are you doing to educate yourself on 1) how your health insurance works and 2) a strategy for spending your health care budget wisely? Let's start with the very, very basics. Know your insurance terms:
PREMIUM. This refers to the amount you pay, usually monthly, for your insurance. Health insurance, like any insurance, is a gamble. Health insurance companies (like Blue Cross Blue Shield or Aetna, for example) are making a bet that they will collect more in premiums than they will have to pay for your doctors visits, x-rays, prescriptions, etc. after you meet your deductible. Which leads me to my next point...
DEDUCTIBLE. This is the dollar amount that you must pay for your healthcare, per year, before your insurance will start to pay for part or all of your treatment. Not all health related services "count" towards your deductible, so be aware! For example, it is very unlikely that an acupuncture treatment or PRP injection will go towards meeting your deductible. Check on the specifics of your plan. A lower deductible plan typically comes with a higher premium, and visa versa. You may have two separate deductible amounts, an "in network" and "out of network" deductible, which will be covered below.
IN NETWORK VS OUT OF NETWORK. In an attempt to control health care costs, many insurance companies create a network of health care providers who agree to offer certain services at a lower rate. These providers are "in network" with your insurance plan, and going to these specific providers is usually cheaper and contributes to your "in network deductible".
You can still go to a health care provider who is not in your network. You would do this if you know you want to see a specific person because you have heard or experienced good things about him or her. However, you will pay a higher co-pay, co-insurance, etc. The cost of this service will go towards your "out of network deductible" if your plan has one.
COPAY. Some insurance policies forgo a deductible and instead individuals pay a flat fee, or copay, for a medical service. For example, you may pay $50 for a doctor's office visit or $30 to see your physical therapist, and your insurance company will pay the remaining cost of that visit. This type of play is typically a bit more expensive as you are assuming less of the financial risk as the consumer.
CO-INSURANCE: This is what happens when a deductible and a copay make an insurance policy baby. In this situation you pay all of your costs up to a certain amount (a deductible) and then are responsible for a percentage of any costs after that (copay, kind of). For example, you pay the first $1000 of your health care costs for the year and then pay 20% of any fee after that. Again, don't just assume that any health care related service is "covered" by your insurance! Know your plan details, or at least where to find them if you need to.
OUT OF POCKET MAXIMUM: This is a term you never want to really have to know or use. It refers to the maximum amount you will pay in deductibles, copays, and coinsurance. Your insurance will pay 100% after this amount. Typically if you hit this number it is because you are really, really sick. You probably won't be celebrating, trust me.
LEAH'S SOAPBOX. All of this serves to act as an elevator to my soapbox, which I shall now stand on. Included in my figurative list of FAQs is "do you take my insurance?" Let me preface my answer by saying that I am very passionate about affordable health care. I am very, VERY passionate about quality care that is specific, effective, and efficient. I believe that access to healthcare is a a basic right, not a privilege.
And no. I do not accept your insurance.
I will accept your HSA card. I will generate a bill after your treatment which you can submit to your insurance and be reimbursed depending upon the specifics of your individual plan. I am a cash pay practitioner and I believe that this is the best avenue for providing the best treatment I can possibly give you. Here's why:
1. I did not become a physical therapist so that my treatment could be dictated and diluted by arbitrary insurance regulations. I also did not become a physical therapist so that my treatment could be measured by how many patients I see in a day, how many units I can charge per patient, and how many times I can get that patient to come back.
I would have skipped grad school and been a salesperson if that interested me.
2. I became a physical therapist because I wanted to be really, really good at what I do. Oh yeah, and I wanted to help people return to happy, healthy lives with passion and pain free movement.
3. My treatment is effective, and thus valuable to you. You may pay a $40 copay to see a PT in a box physical therapy practice where you will receive limited time with your therapist, cookie cutter exercise prescriptions, and sub par treatment. $40 is all I would be willing to pay, too. It may be cheaper up front, but you are purchasing a service that is also cheap in value.
I will cost you nearly twice that much. I will also spend a full hour with you, one of one, actually listening to your story. I will assess your whole body and all of the possible contributing factors to your symptoms. I will implement specific hands on techniques with I have gathered over 7yrs of higher education and hundreds of hours of weekend continued education courses. I will check up on you to see how things are going and talk through any questions or complications you are having over the phone or via email free of charge. It will be worth the money you pay because you will get better faster, with fewer treatments, and more complete, long lasting results.
4. Plus, I'm good company. Compare value, not dollar amounts when it comes to your health care.
5. I am a concierge physical therapist, meaning I will come to your home or office to treat you. This saves you travel time, time taken off of work, money spent on childcare, the cost of inconvenience, and so on and so on. It requires me to charge more for gas and time I spend getting to you. I've got two cats and a boyfriend to feed, people.
However as stated previously, I am also a loud proponent of affordable healthcare. I have specifically designed treatment options at Nashville Running Company East, Nashville Running Company West, and Franklin Massage Center. This allows me to charge less, and also support local businesses I love and business owners whom I look up to and respect. That is valuable to me, and I am happy to compromise a monetary figure for that opportunity.
So as always, knowledge is power. Empower yourself and empower your friends by sharing this post. Know when to spend money wisely (your healthcare) and when to save it (your morning coffee).
For more detailed information, ask your friendly neighborhood PT.