My wife “Disjointed” her knee a couple months back, it moved left to right. Nothing was torn, no surgery, just a swollen knee. She hyper extended the same knee in 09’ so she decided to go to physical therapy.
We just got the bill, for the therapy only, she had the X-rays/MRI’s done elsewhere…9 half hour sessions, just shy of 4K. The insurance company paid just shy of 2K and we are staring at another 1900$ on top of that. The last time I had physical therapy was for a running injury in 06’. At the time I paid from my HSA and I did a similar 30-45 minute session and I paid then $100-150 a pop. The price for this is over $800 and hour.
Before I go completely bonkers on the place what are these services going for and do these prices seem out of line? Apparently the insurance company did which is why they only paid about half the total, which to me, at $400 plus an hour seems generous.
That being said what are my options here? I have in the past had places tell me they would just take whatever the insurance company paid, even without me asking. I will take that approach first. Outside of that who does one approach when the service cost seem out of line? Other than that I have the “I’m not paying it option” or possibly the “I’ll pay $1.90 a month for the next 1000 months option”.
~Matt
Edit to add: The above prices are in comparison to the cost of getting my kids finger fixed from being broken from start to finish for less then 1K. That price included three sets of X-rays, three doctors visits, a cast and a splint. Again the two do not seem equitable…to me.
I went through PT last year for my shoulder. It was $100 - $120 per 30 minute session, depending on the work done
EDIT: Maybe there’s some kind of billing error. The rates they charged you seem way out of line. I’d call them to discuss.
That’s about what I had in mind and didn’t even think to have my wife get an idea on price due to my past experience. I was expecting 100-150$ an hour and that the insurance company would cover most of it. My wife has already called and their “Billing department” basiclly said “Yep that is what it is”, but like you said they are just looking at the numbers and if the code matches the price they are probably saying it’s good.
I just wanted someone to tell me what I thought I already knew and that those prices are WAY out of line. Even at a high cost of 200$ a session it’s less then what the insurance company already paid.
We were HSA up until my son was diagnosed T1D and then it no longer made sense. Last year when we made the switch the actual difference between policy costs was actually pretty minimal compared to what it was 7-8 years ago when we first switched to HSA.
What I found that for small costs like these sessions, it made sense to just pay cash and then pull the money from the HSA and reimburse yourself. Then the company didn’t have to deal with the Ins Co at all and often times lowered their prices even more.
My reference may not be relevant as I’m in Canada, but things like physio, chiropractors etc aren’t covered under our medical so we pay out of pocket. Typical visits are $70-100.
I would assume there is some kind of mistake and go in with that approach. I would go ape-shit if that was their actual rate. Who the hell would pay $800/hr for basic physical therapy?!
First question, what can they do in 30 minutes. I’ve been working with a PT to strengthen my left glute/hip/quad for the past 6 weeks and my warm-up takes 30 minutes. The session started out at about an hour and a half and it’s now two hours. Secondly, there is something wrong with the billing. Don’t accept what the person in billing has to say, they are probably in a separate office and do billing for anybody. You or your wife need to talk to the owner about this. No PT charges $800 per hour!
irst question, what can they do in 30 minutes. I’ve been working with a PT to strengthen my left glute/hip/quad for the past 6 weeks and my warm-up takes 30 minutes
Not 400$ worth For the most part they did a few mobility tests every week, tested strength, checked loseness of the joint etc. She did everything else at home including exercises every day etc.
Certainly there is variation on billing charges based on location, however in general I see my patients for 60 min evaluations and 45 min return visits one on one. Our charges to insurance are typically $120-200 depending on what visit, what we did etc. Now Insurance will reimburse a certain amount and with most insurances we are required to write off anything above the agreed upon contract. Meaning usually we can go after the patient/client for $20-40 a session, but that’s about it. If someone were to pay cash we discount our prices for not having to go through the huge hassle of billing insurance.
From a physical therapist, while I certainly believe in general we are an undervalued commodity, the prices you mentioned are way out of line. As other’s have said I would go in with the mantra that there must be some mistake. You could even cold call other offices in the area and see what their typical charges are - arm yourself with ammo. Maybe we are all crazy and that is the rate in your area (I doubt it…but maybe).
Does your insurance negotiate reasonable and customary charges for each treatment? Sometimes medical billers try to bill insurance hundreds, but the negotiated might be 1/5 of that. the insurance pays a certain percentage of the reasonable and customary after deductible and you pay there rest of reasonable and customary. some companies try to bill you the difference from the total billed, but you are only responsible up to the reasonable and negotiated. For me these negotiated amounts make insurance worthwhile as I am not hitting my yearly deductible and am basically paying the full cost of reasonable and customary. I would hate to have to be uninsured and be paying the full billed price.
some companies try to bill you the difference from the total billed, but you are only responsible up to the reasonable and negotiated.
This was going to be my out for not paying what the insurance company did not pay, but even what the insurance company paid appears to be about twice what I was expecting or at least pretty high. The insurance paid ~2K or so on nine 30 minute sessions, ~200$ a session.
I suspect, especially since the reinforcement here, that something was billed wrong.
Matt, I’m sorry your wife is having knee issues and I hope the PT helps her. I do think your costs are high. I’m lucky my company pays PT costs.
I had such bad knee issues that I was falling, tripping and could hardly walk; and I was registered for Lake Placid Ironman in 2011, so I used our company PT guy. After a few sessions, my issue was worse, so I quit PT.
I focused on indoor bike training and just started training. I really think the indoor bike training on a Lifecycle strengthened my knee and made it more stable. I completed the IM. My time wasn’t great, but I think it was a miracle I finished.
That being said, I haven’t had a problem with my knee since. I really believe the bike training helped to heal me. If I had stayed with this PT guy, I’d still have issues. I know it.
Overall, I hope the PT works for your wife and she’s 100% soon. I just had to share my story. Happy Weekend.
What does your EOB from the ins co say? They often say “x is the max you can be billed” after their payment. I used to prescribe a lot of PT in your area, and $800/hr is WAY out of line.
Absolutely price gouging. Ask to see their coding and documentation. Almost all pt codes are timed codes. If you are only there for 30 minutes, there should only be 2-3 codes. I’ll bet there are a lot more than that. I’d be highly suspiscious of billing fraud based on the info you have presented.
Not asking you to pay your portion or “just taking what the insurance company pays” is also insurance fraud FYI.
From my perspective as a Physical Therapist 307trout’s assessment is right on the money. Check what billing codes were used for each session and then have you or your wife contact the provider. I would personally ask your wife to call and try to speak to the PT about the charges. Force the PT to justify their charges and if they can’t then talk to billing immediately.
Unfortunately insurance fraud is prevalent throughout medicine in many different areas including PT. I hear about cases of fraud from current patients about my competitors daily.
Bottom line I am not receiving anywhere close to those reimbursement rates for a 60min followup appointment. PT’s like your wife’s devalue my profession and reduce my reimbursement, keep pursuing this!
I pay $90 per month for 8-10 15-minute sessions, which I either pay out of pocket or run through our MSA. They are this low because they don’t file insurance - the patient is expected to do it. I would look around your area to see if there is a PT that offers this model.
I’ve seen five PT’s over the past few years. Charges have been anywhere from $50 per half hour session to $200, 3 of the five were between $100-$150. $400 per session AFTER your insurance already picked up half the bill seems absurd to me, to the point that I wonder if they added an extra 0 at the end and meant to charge $80 a session or something
Does your insurance negotiate reasonable and customary charges for each treatment? Sometimes medical billers try to bill insurance hundreds, but the negotiated might be 1/5 of that. the insurance pays a certain percentage of the reasonable and customary after deductible and you pay there rest of reasonable and customary. some companies try to bill you the difference from the total billed, but you are only responsible up to the reasonable and negotiated. For me these negotiated amounts make insurance worthwhile as I am not hitting my yearly deductible and am basically paying the full cost of reasonable and customary. I would hate to have to be uninsured and be paying the full billed price.
I bet this is it. It’s my experience that healthcare providers charge outrageous prices on the intial billing, only to have the insurance company knock it down to a reasonable and customary charge.
Never pay the initial bill from the provider. Wait for the insurance statement and see what is actually owed after deductibles, etc.
Matt im also a therapist and agree with others that those bills are insanely high. For what you are describing i would only bill 2-3 units tops. Something smells here. Find out what was billed each visit, see if that jives with the treatment your wife got. If not, raise a big stink and file a co plaint if you have to.
I’ve been going to a PT for some time now. His “insurance price” is $175-225/hr depending on what he does. He discounts if you pay him the entire fee at the time of service and do the insurance submission yourself. He is a one man show and has no office staff. Since he is out of network for me, I handle the billing and end up getting partially reimbursed. My husband’s PT doesn’t do insurance at all, but will also provide a superbill so you can submit it yourself. She is in extremely high demand and her rates aren’t as high as what you’re being charged, and these people are in downtown SF.
Unless your wife is getting some seriously complicated treatment I have no doubt that you are being overcharged.
Usually there is a negotiated rate and a write off. My husband just got his “$8,000” surgery bill, of which $6,900 was “written off” through negotiated rates with the ins co, and then they covered their bit and now we are responsible for ours. Something doesn’t seem right here. I do know that our insurance policy has “acceptable amounts” that providers can charge for treatment, and if a provider is in excess of that, we could end up being responsible for the balance. I wonder if something like that happened here.
Another thing I had happen was a large PT clinic that charged a $95 “facility fee” with each visit. Insurance won’t cover that. I got out of there quickly. Paying my guy cash is cheaper than going there and paying that fee plus my co-pay.
For the most part they did a few mobility tests every week, tested strength, checked loseness of the joint etc. She did everything else at home including exercises every day etc.