Buying health insurance is easier—and faster—than it’s ever been. Much like fast food, however, speedy convenience now can cause plenty of woe later. (For example, I’m betting a good portion of your patients purchased plans without even knowing how a deductible works for health insurance—let alone what their deductible actually is.) But as unpleasant as a post-taco-run stomachache can be, surprise medical bills are much more painful.

Untapped Potential: The Art of Discovering and Selling Your PT Value - Regular BannerUntapped Potential: The Art of Discovering and Selling Your PT Value - Small Banner

I’ll take the #2 with the large deductible.

Does this scenario sound familiar to you? A patient with a painful problem needs your office’s help. He or she calls to schedule an appointment. After you cheerfully schedule the patient, he or she asks, “So, how much is this going to cost?”

“Uh-oh,” you think. You explain to the patient that his or her copay will be $50 per visit, but that’s after the patient has met his or her deductible—which is $5,000. Furthermore, the patient’s coverage is subject to prior authorization—and don’t forget that PCP referral, as the one from the patient’s surgeon isn’t enough on its own. Oh yeah, and the patient’s policy is limited to 20 PT visits per year. After that, insurance will stop paying.

The patients who come to my office come for relief from their aches and pains, and I want to be part of that relief. But how can I when it’s my job to deliver what frequently ends up being bad news? And why are people so shocked to find out the details of the insurance plans that they are choosing for themselves?

Wait—I didn’t order this. Did I?

Health insurance is complicated. And just like I should never, ever be allowed to order off of a Spanish menu without help from someone fluent in the language (“Salsa de pimienta fantasma? Sounds delicious!”), our patients shouldn’t be choosing their health plans without help from someone who understands the terms of those plans. And preferably, they should be receiving that help before potential problems arise. With many people skipping brokers and agents altogether, the responsibility of explaining plan benefits often comes down to us: the provider’s billing, reception, or management staff. Although we’re not insurance salespeople—and can’t necessarily recommend one plan over another—we can teach people what we know and thus, help make them savvier consumers.

In my experience, there are three areas in which patients need our help:

1. Definitions of Terms

Has a patient ever told you, “I shouldn’t have to pay anything because physical therapy is covered?” (Insert Inigo Montoya meme here.) You can be “covered” for a service and still have a $10,000 deductible or an $80 copay, and when you’re paying that much money out of pocket, the term “covered” suddenly loses its comfort.

2. Referral Requirements

As an outpatient PT office, we see a lot of post-op patients coming in with referrals from their surgeons and orthopedists, and patients become rightfully perplexed when we ask for yet another referral from their PCP. After all, their primary doctors often haven’t been very involved in the surgical care episode. On top of that, some plans tout that no referral is required, but in some cases—often unbeknownst to the patients—if they do get a PCP referral, it can help reduce their cost-share. And all of that doesn’t even take into account the different direct access laws for each state—which may or may not conflict with the insurance policy. Confusing? You bet!

3. Medicare Secondary Payers

Through the years, I’ve noticed that more and more Medicare secondary payers are paying less and less. Many of our Medicare patients laugh when they get a measly bill with a dollar-and-change balance for each visit that their secondary has deemed “patient responsibility.” Dozens of our patients this year were also shocked that their Medicare deductible wasn’t covered by their secondary insurer.

Translate the menu, por favor!

Give a man a fish fajita and you’ll feed him for a day; teach him how to fish—okay, you get the picture. Education is key! Rather than simply explaining how much a single physical therapy visit is going to cost, it’s time for us to help our patients learn how to determine that information for themselves. My goal isn’t to put my front office staff out of a job, but to reduce the amount of sticker shock our patients experience—in our office and elsewhere. (For a more detailed overview of strategies for suppressing sticker shock, check out WebPT’s most recent webinar.) After all, there is nothing more discouraging than seeing my PT colleagues work so hard to help patients feel better, only to have those patients quit prematurely due to cost or confusion over their insurance benefits.

To that end, I’ve teamed up with WebPT to create a comprehensive, easy-to-read guide to help your patients:

  • learn what common insurance terms mean (and don’t mean);
  • ask the right questions while shopping for insurance—thus help them avoid surprises later; and
  • understand how to read an Explanation of Benefits to reconcile their medical bills and track deductible and out-of-pocket spending.

Download the PT Patient's Guide to Understanding Insurance

Patients confused about their insurance coverage? Avoid uncomfortable conversations later. Enter your email address below and give them the PT Patient’s Guide to Understanding Insurance.

Please enable JavaScript to submit form.

What strategies have you implemented in your practice to help contend with patients’ confusion over insurance coverage? What’s worked—and what hasn’t? Share your experiences in the comment section below.


  • The PT Patient's Guide to Understanding Insurance Image

    downloadApr 3, 2017

    The PT Patient's Guide to Understanding Insurance

    Patients are shouldering a greater portion of their healthcare costs than ever before. But when they don’t know the specifics of their coverage, they can end up with much bigger bills than they bargained for—and that often leads to unpaid balances and unfinished treatment plans. Bring them up to speed—and improve your practice’s collections and patient retention—with this guide. Patients will learn: What it means for a service to be “covered.” How to define common insurance terms. …

  • Insurance Coverage Confusion: Why Uninformed Patients Lead to Unpaid Balances Image

    articleApr 17, 2017 | 5 min. read

    Insurance Coverage Confusion: Why Uninformed Patients Lead to Unpaid Balances

    People buy lots of products without truly understanding how they work. But unlike that automatic wine corker you impulse-bought from Brookstone last month, not every purchase comes with a 20-page instruction manual—or ends up working the way we imagined it would. For many consumers, that frustration definitely applies to the health insurance selection process. And that’s especially true for those who are new to the insurance market —for example, the millions of Americans who recently gained access …

  • 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 …

  • 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 …

  • Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid Image

    webinarApr 19, 2017

    Down with Denials! 5 Claim Fixes to Make Sure Your PT Clinic Gets Paid

    One denied claim might not sound off your billing alarm bells—but in reality, it should. That’s because—as with faulty plumbing—one leak often indicates a much larger issue. And all too often, rehab therapy practices fail to act quickly enough—and soon find themselves wading in a flood of lost revenue. But there are simple, proven, and affordable ways to not only plug your billing holes, but also reinforce your whole system so you’re less likely to bust a …

  • What to Look for in a PT Biller Image

    articleJul 28, 2015 | 4 min. read

    What to Look for in a PT Biller

    In the words of American rock legend Tom Petty, “Good love is hard to find.” While I agree wholeheartedly with Mr. Petty’s wisdom, I think some rehab therapy practice owners might say good employees are even harder to find. And that certainly applies in the billing department. After all, your clinic’s billing operation is crucial to its financial well-being. One bad hire could mean the difference between your clinic achieving private practice rockstardom and hitting rock bottom. …

  • 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 …

  • 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, …

  • Combatting Health Insurance Illiteracy: How to Help Patients Understand Their Plans Image

    articleApr 24, 2017 | 5 min. read

    Combatting Health Insurance Illiteracy: How to Help Patients Understand Their Plans

    Last week, WebPT’s Brooke Andrus wrote a post explaining why patient confusion about insurance coverage can translate into problems for your clinic—everything from angry and frustrated patients to unpaid balances. According to PJ Cloud-Moulds—author of this Physicians Practice post —“there is a huge gap between reality and what the patient thinks happens with their insurance plan.” That’s why—whether it should fall on providers’ shoulders or not—many PTs, OTs, and SLPs are stepping up their educational game to …

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