Is private pay pelvic floor physical therapy affordable?

by Bethany Peterson December 4, 2023

Comparing private pay options with insurance coverage

The common belief among most Americans is that private pay providers are wildly expensive, and the only way to get affordable healthcare is to go through insurance.

That’s not always true.

When you compare a single pelvic floor physical therapy session at a private pay or out-of-network clinic like Well + Core to a single physical therapy session at a clinic that accepts insurance, the prices may look vastly different. However, it’s important to consider your entire physical therapy journey to calculate the true costs over time.

We’re not here to tell you that private pay or out-of-network is ALWAYS cheaper than using health insurance. But we are here to tell you it’s worth running the numbers.

Comparing physical therapy prices

One of the biggest differences between physical therapy at an insurance-based clinic and a private pay clinic is the amount of time you spend with your physical therapist.

Your appointment at most insurance-based clinics will include 15-30 minutes of time with your physical therapist. At Well + Core, your initial appointment is a 90-minute evaluation and follow-up appointments range from 30 minutes to an hour. Every single minute you spend inside our clinic is spent one-on-one with your physical therapist.

Because we can cover more ground in less time, you will typically need fewer appointments at Well + Core. Here’s an example of the financial and time commitment between the two options assuming a $60 co-pay and an 8-appointment requirement dictated by insurance.

A chart comparing the total cost of physical therapy that is covered by insurance versus with a private pay provider. For physical therapy covered by insurance, the cost starts at $60 and increases by $60 for each appointment. For physical therapy with a private pay provider, the cost starts at $200, then increases to $350 for the second appointment, and finally increases to $500 for the third appointment.

This chart compares the average amount of minutes spent with a physical therapist covered by insurance versus with a private pay provider. For minutes spent with a physical therapist covered by insurance, the amount starts at 20 minutes and increases by 20 minutes every appointment. For minutes spent with a physical therapist who is a private pay provider, the amount starts at 90 minutes then increases to 150 minutes by the second appointment. And finally increases to 210 minutes for the third appointment.

Since private pay clinics do not answer to insurance companies, we can cover more ground in fewer appointments. When calculating total cost, keeping the number of sessions you’ll need in mind is essential.

Insurance companies often dictate a certain number of appointments you must attend. On average, that’s 6-10 appointments. During each appointment, you’ll spend approximately 15-30 minutes with an actual physical therapist.

Private-pay clinics ensure you spend your entire appointment (60-90 minutes) with your physical therapist. That’s why your progress is often faster, more efficient, and more effective with a private-pay provider than one who has to abide by insurance rules.

*This chart serves as an example of a typical price comparison. Prices are based on $60 co-pays vs. a $200 initial visit plus $150 follow-up visits for private-pay. Prices will vary from clinic to clinic.

Comparing physical therapy prices: If you haven’t met your deductible

Many insurance companies do not begin paying for physical therapy until after you hit your out-of-pocket max. In this case, the numbers are simple. One appointment with an insurance provider may cost $200 or more for less time spent with a physical therapist.

Comparing physical therapy prices: Hidden costs of waitlists

Accessibility is a huge problem among clinics that accept insurance. You may need to get in to see a physical therapist but have to wait up to three months to be seen. Or perhaps worse, you may have your initial evaluation but have to wait weeks or months for follow-up appointments. Often, you’ll have to schedule 8-10 appointments all at once, planning months in advance.

By the time you get in to see your physical therapist, you’ve already lost valuable time in your healing journey.

Private pay clinics tend to have more flexibility and availability because our audience is naturally smaller and we have more control over our own schedules. At Well + Core, we can typically schedule appointments with a week’s notice. Plus, you can just pop onto our website to book your appointment vs. calling the clinic and then your insurance company a thousand times before you are approved to get seen.

Save by using HSA, FSA, or submitting a superbill to your insurance company

Private-pay providers generally accept your HSA or FSA dollars if you have them. If you don’t, we can also provide a superbill that you can submit to your insurance for reimbursement. Our patients are often successful at getting at least partial reimbursement for their treatment, AND the money they spend with us typically counts toward their annual deductible or out-of-pocket maximum.

If you are pregnant, it might be worth getting in more visits before you deliver. The money you spend on appointments should count toward that out-of-pocket maximum and make the cost of your delivery cheaper. (Just another reason not to wait until you’re postpartum to see a PT!)

Higher quality of care and patient-centered treatment

It baffles us that people who sit behind a desk at your insurance company are in a position to tell doctors how to treat their patients. If you go to the doctor for a knee injury, but the doctor finds something wrong with your hip, you have to schedule a different appointment to address the hip issue. It’s insane.

Your health is complex. When you come in for pain in one area, private-pay providers have the freedom to see what other areas of your body may be contributing to that pain. Additionally, we focus on your goals and how to make your whole body healthy so that you can feel better faster.

We will continue to see you for as long as needed but will never schedule unnecessary appointments just to satisfy an insurance company. You’ll never run into a long waitlist or hear the words “early discharge” or “you’ve run out of visits” from us.

When you’re ready to be discharged, you will be! And if you ever need to return for anything, you can. Sometimes, we can even reduce these return visits to 30 minutes, saving you time and money.

PS: If you’re scrambling to get into your provider by the end of the year because you’ve met your deductible, chances are you’ll be looking at an appointment next year, anyway. If you want to be seen earlier, please contact us, and don’t let your condition go untreated!

Schedule a pelvic floor physical therapy appointment

Interested in a private-pay physical therapist in Kansas City? We’d love to meet you. Book a free 15-minute phone consult to learn more about what Well + Core can do for you, or book your first in-person appointment with one of our pelvic floor physical therapists today.