Private Pay vs. Insurance for Physical Therapy: Which Option Is Right for You?

When you decide to see a physical therapist, you usually have two options. You can find a provider your insurance covers, or you can go to a private pay or cash-based clinic and pay for the appointments yourself.

Which option is better? It might seem like choosing a physical therapist who takes your insurance is the more economical option. But that’s not always true. You may get faster results from the customized 1:1 care that a private pay or cash-based provider offers, which can reduce the overall amount you pay for treatment.

Both types of physical therapy practices have pros and cons. When you understand the differences between them, you can make an informed decision and choose the one that’s right for you.

Understanding private pay & insurance-based physical therapy

The main difference between these two approaches is not only related to payment, but also has an impact on the quality of treatment.

Cash-based PT

If you choose a private pay physical therapy clinic, you’ll be responsible for covering the cost of your sessions. You’ll know how much the initial assessment and each follow-up session will cost, and you’ll typically be expected to pay for each session at the beginning or end of the appointment.

A private pay provider doesn’t need to wait for authorization from your insurance provider or get a referral from your doctor. They can build a customized care plan specifically for you based on your body and goals without any insurance company limiting the number of sessions or types of treatments.

Insurance-based PT

If you choose an insurance-based physical therapy plan, you’ll need to find a provider who is covered by your insurance plan. Depending on your provider, you may be able to select from in-network or out-of-network PTs. In most cases, choosing an in-network provider will reduce the amount you pay out of pocket.

Your insurance provider may cover all or part of the cost of your PT care. You might have a copay at every appointment or not, depending on your plan. 

However, because the insurance company is paying for your care, it also has the power to approve or deny your claim. Even if your insurance provider approves you for physical therapy, there might be a limit to the number of sessions you can have or the types of treatments the therapist can use.

How the pay structure impacts your physical therapy experience

While the most obvious difference between these options is the payment structure, your experience might also be impacted.

Initial assessment

If you choose a private-pay PT clinic, you can make your assessment appointment based on your schedule and the therapist’s availability. You don’t need to get a referral or fill out any insurance forms.

If you choose an insurance-covered provider, you might need to get pre-authorization from your primary care physician or the insurance provider. The therapist may have to conduct your assessment following the insurance provider’s one-size-fits-all procedure. 

Ongoing care

If you go with an insurance-based physical therapist, you will probably have a limited number of visits covered by your plan. Additionally, these sessions tend to be shorter — sometimes only 20 or 30 minutes long. You may see the same therapist throughout your treatment plan, but not always, and your therapist may actually be seeing up to 4 patients during your appointment time.

Most private pay clinics offer sessions that are around 50 minutes long. You can schedule as many sessions as you like. 

For example, if you initially come to PT for injury recovery, you can choose to continue seeing your therapist after healing so they can help you build strength and optimize your movements to prevent future injuries. In most cash-based practices, you’ll see the same provider at every visit.

Many cash-based clinics take a holistic approach to care. They may combine Pilates and PT movements or incorporate strength training — options that may not be covered by an insurance provider.

Insurance-based physical therapy pros and cons

Insurance-based physical therapy offers specific advantages and challenges:

Pros

• Potentially lower out-of-pocket costs

• Possible coverage for long-term chronic conditions

• Access to an established network of vetted providers

Cons

• Potential restrictions on treatment options and number of sessions

• Possible requirement to get a referral or pre-authorization

• Potentially higher overall costs if it takes longer to see results

Private physical therapy pros and cons

Likewise, there are benefits and challenges to cash-based physical therapy

Pros

• Personalized 1:1 care with the same therapist

• More flexibility in treatment approaches and timelines

• More cost transparency and privacy

• Usually faster recovery times because of individualized care

Cons

• Potentially higher out-of-pocket costs

• May take longer to compare and choose a provider

Choosing the right type of physical therapy for you

Each type of PT offers unique benefits and challenges. The right one for you is the option that best aligns with your needs, goals, and priorities.

For example, if it’s important to you to avoid higher up-front costs, it might be best to choose an insurance-based provider. However, if you want highly personalized 1:1 care that can reduce the overall time your treatment takes (and, by extension, the total cost), a private pay provider is the better choice.

If you’re still not sure, it might be worth it to contact a few physical therapy clinics and ask some questions:

• How long are the sessions?

• What’s the up-front cost?

• How long does the treatment plan usually take?

• Will I see the same provider each week?

• Does my insurance limit the number of sessions I can attend?

• Can the therapist adjust my treatment plan at any point?

The more information you can get ahead of time, the easier it will be for you to choose the option that’s best for you.

Choose Pilates in the Grove for outstanding physical therapy 

If finances are a top priority to you, insurance-based physical therapy may be the best choice. Be aware, however, that your treatment may be limited by your insurance provider’s restrictions. Shorter sessions with different therapists may slow down your recovery, which might mean that your out-of-pocket costs rise over time.

If customized care and efficiency are your top priorities, a private pay clinic is probably the better choice. You’ll pay for each session up front, but you’ll have more control over your treatment. Plus, you’ll see the same therapist each week for longer sessions, which can lead to faster results that last longer.

Here at Pilates in the Grove, we offer comprehensive physical therapy services from a team of highly qualified experts. At our Miami physical therapy clinics, you’ll get personalized 1:1 care that yields better, faster results.

Ready to experience the benefits of customized physical therapy? Book a physical therapy assessment at our Coconut Grove of South Miami studio today!