In our 2019 State of Rehab Therapy survey, 80% of respondents cited payer requirements as the top reason their organizations require physician referrals as a condition of treatment (even in states with unrestricted direct access). Additionally, high copays and coinsurances were by far the top-ranked regulatory issue in terms of impact to the physical therapy industry and profession. In other words, as it stands, the insurance industry (and its propensity to shift costs onto patients) isn’t making it easy for us as rehab therapists—or the people we serve. 

That said, I still don’t believe that insurance companies are the enemy—or that we benefit from an “us vs. them” perspective. After all, we both (ostensibly) want the same thing—positive outcomes for our patients at reasonable costs—even if we don’t see eye to eye on how to achieve that objective. Thus, the best action we can take is one that unifies us (as much as possible) and builds the foundation for a mutually beneficial relationship that meets our respective needs—and the needs of our patients. To that end, here are three strategies for combating high patient copays (without becoming combatant with payers, tempting as that may be):

The Complete Guide to Creating a Physical Therapy Clinic Website - Regular BannerThe Complete Guide to Creating a Physical Therapy Clinic Website - Small Banner

1. Leverage data to demonstrate the value of rehab therapy. 

While this is more of a long-term play, it’s one of the most high-value strategies we can employ. That’s because rehab therapy is unquestionably effective, lower cost, and low risk. Thus, it’s a practically perfect solution to the opioid epidemic our country is currently facing. Providers, payers, and patients are all more open than ever to safe therapeutic interventions—the kind that qualified rehab therapists provide—even if it takes longer than more convenient, yet possibly lethal, medications. 

So, what’s standing in our way to becoming the go-to solution for musculoskeletal pain and injury? Our industry’s lack of objective data. We absolutely must collectively track outcomes data and use it to reinforce our value as individual providers and practices—and as a profession. As it stands, nearly 22% of organizations—or a little more than one in five—do not collect or track patient-reported outcomes (according to our survey). Of those that do, only 17.6% use that data to support their negotiations with payers. Yet, that is the only way we’re going to move the needle with payers and other providers and establish ourselves—once and for all—as care coordinators who deserve higher reimbursements and more extensive coverage from patient insurance plans. Bonus: Use your data wisely (i.e., to market to providers and patients—as well as negotiate with payers), and it may even garner you better referral relationships, more direct access patients, and more favorable insurance contracts, leading directly to improved revenue.

Data in Action

Don’t believe it’s possible to effect wide-scale change with data? In a study conducted by Boston University and jointly sponsored by UHC/Optum and the APTA, researchers found that patients were more likely to choose conservative first-line treatments such as rehab therapy (which aligns with clinical guidelines) when they had lower levels of cost-sharing (e.g., lower copays and deductibles). While this may not seem like groundbreaking information, having the objective data made it possible for UHC to implement a new policy to waive copays and deductibles for a beneficiary’s first three physical therapy sessions. The last I heard from David Elton—Senior Vice President of Clinical Programs at Optum—the payer is also considering improving reimbursement rates for physical therapists based on patient outcomes. Boom. This is a wonderful first step, and it likely won’t be the last. As I wrote here, “if the results of this study were significant enough to convince one of the nation’s largest payers to make physical therapy more accessible to its beneficiaries, it’s reasonable to conclude that other major payers will take notice—and potentially follow suit.” But we can’t just sit on our laurels and wait. Instead, we’ve got to: 

  • Leverage this data in our conversations with payers and other providers; 
  • Collect and use our own outcomes data to support the value of our services; and 
  • Advocate for more large-scale studies that will demonstrably prove our effectiveness as first-line providers.

2. Provide exceptional service.

One of the best ways to combat high copays—and to continue attracting patients, even those who have to pay a lot out of pocket to see you—is to provide unparalleled service. In other words, give your patients an experience—and results—that they can’t receive elsewhere. Of course, that starts with the obvious—exceptional, evidence-based patient care and outcomes—but it also extends into the less obvious, like: 

Patients as Patient-Consumers

A few years ago, WebPT CEO Nancy Ham and I hosted a webinar about serving patients with high-deductible health plans—and thus, high out-of-pocket healthcare costs. In it, we discussed how today’s patients are much more like consumers, which means they want to feel like they are receiving commensurate value for the amount they’re paying. And who can blame them? That’s why the patient experience—which encompasses everything from the first interaction a patient has with your clinic to the last—now matters more than ever before. As a helpful exercise, put yourself in your patients’ shoes and traverse their journey with your practice. Are there interactions or touchpoints that need shoring up? Or big gaps where patients may feel overlooked? That’s where I’d recommend starting to ensure the service you’re providing is truly exceptional. (Good news: There are exceptional software solutions you can leverage to maximize the impact of your touchpoints and thus, improve the patient experience without creating extra hours of work for you or your staff.) 

3. Be upfront with patients—about the value of your services and the cost.

Conversations about financials can be personal and challenging, but there is no room for beating around the bush when it comes to the cost of healthcare services. After all, surprising a patient with a bill he or she didn’t expect is a sure-fire way to lose that patient—and earn a scathing review. Instead, I recommend verifying patient eligibility within 72 hours of booking a new patient appointment (ideally, before the patient arrives for his or her first session) and then, based on the information you garner from the payer, communicating to the patient his or her financial responsibility. Whatever you do, don’t wait to discuss the cost of treatment until your patient completes a visit and you send out a bill; rather, set clear expectations from the beginning and get patient buy-in to the treatment process. This will help ensure that copays and coinsurances—even high ones—don’t interfere with your patients completing their plans of care and ultimately, meeting their goals.

This might take some practice, but the best thing we can do is communicate the cost of our services with confidence—fully owning and expressing our value. If we’re timid, hesitant, or apologetic, our patients are much less likely to believe in our ability to serve them well. Think about it this way: Patients have few qualms about paying athletic trainers and massage therapists—most likely because those providers have no qualms about charging clients directly, and they’re clear about their value proposition

Online Reputation

You can even start communicating your value to prospective patients before they ever set foot in your office (and thus, mitigate high-copay sticker shock) via an active, professional online presence complete with stellar patient reviews (i.e., social proof that you’re worth the cost). But, how do you generate overwhelmingly positive reviews? Assuming that you’re already providing unparalleled service as discussed above, all you should have to do is ask. Just be sure you’re only asking the patients who you know are loyal to your practice, because even one negative review can turn off a potential patient. To do that, implement Net Promoter Score® (NPS) tracking®. This super-simple metric is extremely easy to digitize—which means you’ll be able to avoid the most problematic biases associated with traditional satisfaction surveys—and provides actionable insights into specific patient issues and trends. Not only can you use it to address those specific issues and trends quickly—thereby improving the patient experience and hopefully retaining any peeved patients—but you can leverage your already-loyal patients to be brand ambassadors, singing your praises both offline and online.


As with everything in life, our attitude matters—and that’s especially true when we come up against challenges or perceived obstacles. Right now, payers’ prohibitive policies and limited perspective on our value are preventing many patients from seeking our care and experiencing the benefits. But that doesn’t have to be the case forever—and we’re already seeing small shifts that may soon lead to bigger ones. So, the question is: How else can we show up to ensure things are moving in the right direction? I’d love to hear your thoughts. Please share in the comment section below.

  • Founder Letter: 3 Ways Your Practice is Losing Money Image

    articleMay 5, 2016 | 7 min. read

    Founder Letter: 3 Ways Your Practice is Losing Money

    Much like the patients you treat, your practice can appear healthy on the outside despite significant internal issues. And when those issues are money-related, the consequences can be deadly. If your practice already is in the red, you know you’ve got some pretty serious cash flow problems. But even if you’re in the black every month, you may still be washing dollars down the drain. While there are myriad ways your practice might inadvertently be losing revenue, …

  • 4 Keys to Keeping a Steady Cash Flow Image

    articleMay 18, 2016 | 5 min. read

    4 Keys to Keeping a Steady Cash Flow

    As a private practice clinic owner, you’re probably familiar with the cold sweat-inducing struggle to keep a steady cash flow. Claims management muck-ups, inefficient processes, staff issues, and lack of insight into your clinic’s financial health can leave you feeling like you’re riding a revenue rollercoaster. So, whether you’re trying to maximize reimbursements , combat employee theft , or optimize patient payments , these four keys to maintaining a steady cash flow will help you even out …

  • Knock Out Patient Dropout: 8 Ways to Increase Retention and Revenue Image

    webinarFeb 12, 2018

    Knock Out Patient Dropout: 8 Ways to Increase Retention and Revenue

    In one corner, we have a highly skilled rehab therapy provider known for delivering amazing clinical outcomes through noninvasive, movement-based treatment. And in the other corner, we have a discouraged, disengaged patient whose quality of life has taken a major hit due to musculoskeletal pain and dysfunction. [video://fast.wistia.net/embed/iframe/d11isduky2]   If you’re a rehab therapy provider, you’ve probably seen this battle play out more times than you can count—and we’re betting that more often than not, your therapy …

  • Common Questions from Our 2018 State of Rehab Therapy Webinar Image

    articleJul 13, 2018 | 21 min. read

    Common Questions from Our 2018 State of Rehab Therapy Webinar

    Earlier this year, we surveyed nearly 7,000 PT, OT, and SLP professionals on the current state of the rehab therapy industry, asking questions on everything from salary and student loan debt to payer mix and patient dropout. We then compiled their responses into our comprehensive State of Rehab Therapy in 2018 report and hosted webinar during which Dr. Heidi Jannenga, PT, DPT, ATC/L, president and co-founder of WebPT, and Nancy Ham, WebPT CEO, offered their take on …

  • Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans Image

    webinarFeb 23, 2017

    Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans

    Copayments, coinsurances, unresolved balances—oh my! Any one of these can cause headaches for healthcare providers, but as healthcare reform efforts shift more and more financial burden to insurance beneficiaries, today’s practitioners are increasingly facing all three. And these challenges are not only hurting their patient acquisition and retention rates, but also their bottom lines. Tired of spending time verifying benefits only to lose those patients to copay sticker shock? Stuck in a constant cycle of pursuing past-due …

  • Stalled Out: 5 Reasons Your Patients Aren't Progressing (and What to Do About Them) Image

    webinarDec 22, 2017

    Stalled Out: 5 Reasons Your Patients Aren't Progressing (and What to Do About Them)

    If life is a highway, then it’s a wild, bumpy one. And while our patients want to ride it (all night long), with all those twists, turns, and potholes, they’re bound to get banged up. Fortunately, you’re here to help get them back in top form. But, helping patients achieve their goals is hard work—for you and for them—and while everyone strives to be a Ferrari, it’s common to plateau at Pinto. And that’s when the risk …

  • Common Questions from Our Stalled Patient Progress Webinar Image

    articleFeb 7, 2018 | 9 min. read

    Common Questions from Our Stalled Patient Progress Webinar

    Earlier this week, Dr. Heidi Jannenga, PT, DPT, ATC/L, the president and co-founder of WebPT, teamed up with Charlotte Bohnett, WebPT’s director of demand generation, to host a webinar on common barriers to patient progress —and strategies for overcoming them. During the question-and-answer portion of the presentation, we received quite a few audience questions on the nuances of fostering patient engagement and moving patients toward their therapy goals as efficiently as possible. We’ve compiled the most frequently …

  • Common Questions from Our Patient Sticker Shock Webinar Image

    articleMar 31, 2017 | 33 min. read

    Common Questions from Our Patient Sticker Shock Webinar

    From copays and deductibles to payer contracts and benefits verification, understanding all the nuances of third-party insurances is tough enough for healthcare providers—let alone their patients. In WebPT’s most recent webinar— Suppressing Sticker Shock: How to Handle Your Patients’ High-Deductible Health Plans —co-hosts Heidi Jannenga, PT, DPT, ATC/L, the cofounder and president of WebPT, and WebPT CEO Nancy Ham provided a lot of great advice on how to have productive conversations about healthcare costs with your patients—without …

  • The State of Rehab Therapy in 2018 Image

    downloadJun 28, 2018

    The State of Rehab Therapy in 2018

    To see results from our most recent industry survey, check out the 2019 State of Rehab Therapy Report. To say that the healthcare industry is complex would be an understatement. While the advent of technology has made care more precise, efficient, and collaborative than ever before, it has also put greater pressure on providers to deliver high-value care at scale. After all, big data makes it possible to not only develop the most effective, evidence-based best practices …

Achieve greatness in practice with the ultimate EMR for PTs, OTs, and SLPs.