The PT's Guide to Retaining Patients with Bad Insurance Plans

I don’t have to tell you that insurance providers are notorious for making it difficult for patients to access affordable physical therapy services. And yet, PT patients achieve incredible outcomes and resolve chronic pain every day—without high-cost, high-risk surgeries and addictive prescription medications. In fact, we’ve talked a lot about physical therapists being the secret weapon for solving the opioid crisis—and we’ve definitely witnessed some positive movement on that front with insurance payers. However, we still have a long way to go before that secret is common knowledge. Until then, rehab therapy patients must contend with costly copays and high deductibles. But, there are a few things PTs can do to ease some of that burden (and maybe even strengthen the patient-provider relationship).

Be upfront and honest about the cost.

During a recent visit with one of my own healthcare providers, I went up to the front desk and received a nasty surprise: apparently, I had an outstanding amount due from my last visit—despite having paid what I owed in full (or so I thought). After a lot of poking around, I finally learned that the provider had collected the wrong copay amount. While I certainly understand that mistakes happen, the fact that I was hit with an extra bill I wasn’t prepared for left me with sour feelings. Fortunately, my provider is amazing, and we have a great relationship—so it won’t stop me from returning to her. But, not every patient will be so understanding—nor can they afford to be. When patients are hit with unexpected fees, many of them never return. Even if they understand that their provider is not at fault, they’ll still wonder whether the provider truly did everything possible to prevent this from happening.

While these types of costs aren’t always foreseeable on the provider end, in situations where it’s a possibility—even a slight one—you should be upfront about it. That way, patients are prepared when it happens.

Educate your patients on the ins and outs of their plans.

I won’t mince words: health insurance is confusing. (Whether or not that’s by design is a matter of debate.) And when patients feel confused about the terms of their plan, it can actually make them less likely to seek necessary care. So, start every initial patient encounter with some Health Insurance Literacy 101. As this WebPT Blog post explains, when educating patients on their coverage, be sure to explain:

• what the cost of the service is (and why),
• key terms and commonly misunderstood definitions (e.g., “deductible,” “covered,” “coinsurance” versus “copay,” and “in network” versus “out of network”),
• visit limitations (e.g., when a plan only allows a specific number of PT visits per policy year),
• referral requirements, and
• rules for Medicare as a secondary insurance.

Pro tip: Before you discuss insurance details with your patients, make sure you have a healthcare literacy lesson plan. Need some help? Download this free insurance guide to give your patients.

Don’t avoid the topic.

You’re a physical therapist—not a financial planner. But the fact is, the rising cost of health care has made the financial side of care delivery an unavoidable topic of conversation—even with patients. Some providers may wish to skirt around the subject, leaving it for their front office or billing staff to handle, but the fact is, leaving that discussion for someone else—or worse, pretending the cost of health care isn’t an issue—breeds distrust. In fact, as the person who interacts and empathizes with patients the most, providers are better positioned to have these candid, one-on-one talks than anyone else in the clinic.

Approach the conversation as an ally.

As this article from the Journal of General Internal Medicine states, healthcare providers “must learn to discuss issues of affordability in a manner that builds, rather than detracts, from a therapeutic alliance.” This calls for empathetic communication—using “we” statements and “I wish …” statements, for example—to foster shared decision-making. The same article gives the following tips for showing empathy during these conversations:

• Employ nonverbal behaviors such as:
• pausing,
• listening,
• nodding, and
• maintaining eye contact.
• Incorporate empathetic language, such as:
• queries (e.g., “Are you concerned about the cost of your care?”)
• clarifications (e.g., “Tell me about how you've dealt with the expenses.”)
• responses (e.g., “I can imagine that dealing with these medical expenses may make you feel…”)

Set realistic expectations.

Last year, we compiled our second annual State of Rehab Therapy report, which revealed that a mere 10% of patients actually complete their entire course of care. That leaves the other 90% ditching PT early. There are numerous reasons behind patient attrition, and of course, it’s not all negative. Some patients simply achieve their desired results before their planned discharge date. (Hooray!) Still, many drop out because therapy isn’t what they expected, and plenty more drop out because they feel PT is too expensive—particularly when it doesn’t produce immediate results. Patients often start therapy and expect to be back in fighting shape in a week, but you know that a power combo of consistency and hard work over the course of several weeks or months is key. So, during your initial visit, be sure to explain what kind of timeline a patient can expect (ideally, with outcomes data to back up your explanations).

Create back-up strategies for those facing financial hardship.

Ultimately, you want to make sure your patients know they’re not in this alone—and that you’ve got their backs. So, when patients come to you with concerns about their inability to finance their health care, make sure you have options to offer them. That could mean:

• setting up payment plans;
• creating a sliding fee scale (if allowable);
• offering financing options; or
• performing services pro bono (in extreme cases).

Consider a cash-pay alternative.

This may seem counterintuitive. After all, cash pay can be a hard sell for some patients when all they see is a hefty price tag—with no guarantee their insurance will cover a dime. However, this option can actually be a better deal for some patients in the end. Not only does going out of network afford you the ability to devote more time and attention to each patient, but also:

• In many cases, you can still give patients an invoice that they can submit to their insurance provider (and put the cost toward their out-of-network deductible).
• Depending on your state rules and insurance contracts, you can offer a discount to patients who pay cash for their services on the same day as their appointment date.

Furthermore, adding cash-pay services to your clinic's offerings can help you attract patients who understand that they get what they pay for and are already willing to cover the full cost of care—thus circumventing insurance woes altogether.

That said, some payers (like Medicare) might actually require you to bill them for covered services, and depending on your patient population, that could make a fully cash-based operation a not-so-viable option. At the end of the day, there’s a lot to consider before delving into the world of cash-pay services. And before you offer any treatment or wellness services on a cash basis (and you plan on remaining in network with certain insurance companies), we highly recommend having an attorney review your insurance contracts and find out if any state laws would further impact your self-pay operations.

Know your worth.

If there’s one thing I’ve learned about PTs, it’s that you all are a pretty humble bunch. Self promotion doesn’t always come naturally, and actively selling your skills may fall outside your comfort zone. However, knowing the value of your services is instrumental to not only convincing high-deductible insurance patients to stick around, but also marketing rehab therapy to patients who don’t even know they could benefit from it.

It may feel like PT is the best-kept secret to pain and mobility issues, but the benefits are plain as day. Hopefully, someday we’ll get to a place where insurance plans reflect that value, but in the meantime, it’s up to therapy providers to enact their own patient retention strategies. Got any other tips for contending with tough insurance plans? Drop us a line in the comment section below!