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 to health coverage via the Affordable Care Act (ACA).

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

Vexing Vocabulary

But that word—“coverage”—is a huge part of the reason why so many previously uninsured people have found the world of insurance so incredibly perplexing. After all, as those of us in the healthcare industry know all too well, just because an insurance carrier “covers” a particular service doesn’t mean it will pay the full cost of that service. And it certainly doesn’t mean the patient won’t have any financial responsibility. Holy counterintuitive, Batman.

Of course, the pervasive lack of insurance literacy that has plagued the post-ACA healthcare world should come as no surprise. According to pre-ACA research cited in this 2013 Forbes article, “just 14 percent of respondents had an understanding of the most basic insurance concepts of ‘deductible, copay, co-insurance and out-of-pocket maximum.’” And a study referenced in this 2014 Kaiser Health News story revealed that only “one in 10 people in the U.S. have a proficient level of health literacy.”  

Burgeoning Balances

Unfortunately, healthcare providers—including physical, occupational, and speech therapists—are often left to deal with the financial fallout of that confusion. In the years since the ACA went into effect, I’m betting you’ve experienced some version of the following chain of events:

  1. New patient calls to schedule appointment.
  2. Front office verifies the patient’s insurance benefits.
  3. Patient completes one or more visits at your clinic.
  4. Patient receives bill after his or her insurance processes the claim(s) for said visit(s).
  5. Patient becomes angry or upset/refuses to pay/never returns to your clinic.

There’s a good chance that in some cases, your practice—despite making a valiant effort to collect the balance due from the patient—has failed to recoup the amount owed. And that puts providers like you in a tough spot. After all, it is not your fault:

  1. that patients enroll in insurance plans without fully comprehending the terms of those plans;
  2. that those patients are often shocked to discover that the services they thought were “covered” aren’t actually covered—at least not to the degree that they assumed; and
  3. that some patients cannot—or will not—pay the high copays, coinsurances, or deductibles that they unknowingly agreed to cover when they purchased their plans.

And yet, here you are, struggling to keep your head above water as the pool of past-due balances gets deeper and deeper. Regardless of who is at fault, you—the provider—are the one who ultimately loses (well, you and the patient, who may end up forgoing the treatment he or she desperately needs). But, you can only do so much—right? After all, you don’t have the time—or even the expertise—to play insurance consultant for every one of your patients.

Still, you must do something. Hopefully, you’ve already implemented a comprehensive insurance verification protocol in your practice—one that allows you to provide cost estimates and collect patient payments upfront whenever possible. Major props if you or your front office staff already use that process as a springboard to have clarifying conversations with your patients. This is a great time to make sure patients understand which expenses they will be responsible for—and why. As the author of this Physicians Practice post points out, “It would be ideal if the insurance company took the time to explain plan details and teach patients how best to utilize their plan benefits. We know this will never happen, as it would be very costly for the insurance company.” So, the author continues, “Take it easy on your patients and find it in your heart to spend the necessary time with your patient; remember this likely someone's dad, mom, sister, or brother.”

Purchasing Power

If you’re pressed for time—and in a busy therapy practice, who isn’t?—consider supplementing some of those face-to-face conversations with educational resources patients can use to get themselves up to speed on the ins and outs of insurance. As PT office manager Asia Giuffrida explains in this blog post, “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.” For that reason, Giuffrida created a patient-facing insurance guide for patients who had questions about their coverage. She hopes the guide will combat some of the sticker-shock that often keeps patients from starting—or returning to—therapy. “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,” Giuffrida wrote.

In the interest of promoting greater insurance literacy across the entire rehab therapy patient community, Giuffrida even teamed up with WebPT to provide all of her therapy peers a customizable version of her guide (you can download it free here).

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.

While the ACA has brought much-needed insurance coverage to millions of Americans, it’s also had some unintended—though somewhat expected—consequences. And that has put a lot of financial pressure on healthcare providers—including rehab therapists. Have you noticed an influx in uninformed insurance beneficiaries in your practice? What have you done to reduce patient confusion—and avoid unpaid patient balances? Let us know 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. …

  • How to Discuss Medical Bills and Insurance with Your Patients Image

    articleApr 7, 2017 | 5 min. read

    How to Discuss Medical Bills and Insurance with Your Patients

    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. I’ll take the #2 with the large deductible. Does this …

  • 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 …

  • The State of Rehab Therapy in 2019 Image

    downloadJun 17, 2019

    The State of Rehab Therapy in 2019

    Each year, we survey thousands of rehab therapy professionals on the metrics, strategies, and complicating factors that influence success in the current healthcare market. In 2019, we received more than 6,000 responses from individuals in a variety of settings, specialties, and geographic regions—and we’ve compiled all that data into the single most comprehensive annual report on the state of the rehab therapy industry.  This report features insights on everything from demographics and financial metrics to regulatory challenges …

  • 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 …

  • Why I Paid $75 Per PT Visit for Two Months Image

    articleAug 24, 2018 | 9 min. read

    Why I Paid $75 Per PT Visit for Two Months

    When I woke up after a night of boot-scootin’ my way down Lower Broadway—Nashville’s famous honky-tonk alley—my head wasn’t the only thing that hurt. In fact, the moment I stepped out of bed, I knew I was in serious trouble, even if I wasn’t quite ready to admit it to myself. Part of me was in denial that I could actually injure myself from swinging through one too many do-si-dos. But, the shooting pain I felt on …

  • 3 Common Rehab Therapy Credentialing Mistakes Image

    articleJul 18, 2018 | 6 min. read

    3 Common Rehab Therapy Credentialing Mistakes

    Proper credentialing is a crucial step in running a successful physical therapy clinic. If your clinic and therapists aren’t properly credentialed with insurance providers from the get-go, your bottom line might suffer. And it’s not just new clinics that are susceptible to making credentialing mistakes; in fact, any clinic that has gone through a change in ownership, rapid growth phase, or any other transition might find itself mired in credentialing headaches. But before we get to the …

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