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Private Practice without participating with insurance companies

 
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Private Practice without participating with insurance c... - May 27, 2007 5:11:00 PM   
PamPT

 

Posts: 20
Joined: May 1, 2006
From: Maryland
Status: offline
I am considering beginning a private PT practice and was wandering if there are any of you out there that run a practice and do not bill insurance companies. I am interested in avoiding billing insurance companies directly, having patients pay cash, check or credit, and they submit their claims to their insurance company directly. Has anyone had any success with this?
Post #: 1
Re: Private Practice without participating with insuran... - May 27, 2007 10:03:00 PM   
goodlooks58

 

Posts: 456
Joined: October 22, 2002
From: CA
Status: offline
This is every private practise owner's dream!. I now have 3 workers comp middle man insurance companes e.g. Medrisk, Alignnetwork and one more, I forgot the name..is offering me $65 per visit with a capitation on the number of visits and also the same 2 procedures/2 modalities. Now, offering $65 in CA is almost an insult due to higher living expenses. $65 is same as massage therapist (LMT)as most LMTs charge $1.00 per minute with max of 60 minutes of massage. These ins. cos want to lower me to the level of LMTs after all the education I have been through.

(in reply to PamPT)
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Re: Private Practice without participating with insuran... - May 28, 2007 11:28:00 AM   
savela

 

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From: toronto
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Hi Pam,

I have been running a practice like that for 5 years now. I am lucky enough to work in Canada and in an area where the pt. can afford to pay and wait a week or so for their return.

I would research the best area to set up. I work in a high income area. I have worked previously in a different area where my pts. were living pay check to pay check and if we did not bill the insurance directly we would not have had any pts. because they could not afford to come for treatment.

(in reply to PamPT)
Post #: 3
Re: Private Practice without participating with insuran... - May 28, 2007 12:48:00 PM   
PamPT

 

Posts: 20
Joined: May 1, 2006
From: Maryland
Status: offline
Thank you two for your reply. The insurance reimbursement issues seem to be a nightmare for most private practice clinicians that I have spoken with. I am a lymphedema certified therapist and hope to treat lymphedema patients in my area of PG county, Maryland. There seems to be a big need, since there are not a lot of clinics that treat lymphedema patients or there is quite a waiting list to get in. I am excited about wanting to plan a private practice career, but very discouraged to have to deal with all the insurance issues. Thanks for the advice.

(in reply to PamPT)
Post #: 4
Re: Private Practice without participating with insuran... - May 28, 2007 11:25:00 PM   
james097

 

Posts: 178
Joined: January 28, 2005
From: West Vancouver BC
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As Savela says a high income area is the place to be. This shouldn't be confused with a rich area.
The best areas are those with government workers and tradesmen and the self employed. They either have insurance and or can't afford to be off work for long. In areas of the rich I have found out they often want to stay rich. In most of Canada it's cash payments and I know of no one who would want to go back to the old ways.
Jim McGregor

(in reply to PamPT)
Post #: 5
Re: Private Practice without participating with insuran... - May 29, 2007 11:30:00 PM   
goodlooks58

 

Posts: 456
Joined: October 22, 2002
From: CA
Status: offline
The high income area in which I live is a mirage. High income people are in the neighborhoods where the home prices are higher which is based upon the rating of the local public schools-the API index. Good schools means more kids means that the larger, more expensive homes means larger mortgages. So peole are mortgage rich and cash poor--They have lousy HMO plans as that is what their comapny gives them. So in the end I end up seeing these lousy HMO plan pts.

(in reply to PamPT)
Post #: 6
Re: Private Practice without participating with insuran... - June 1, 2007 6:47:00 AM   
PamPT

 

Posts: 20
Joined: May 1, 2006
From: Maryland
Status: offline
I would love to work in the area that I live in. But I also live in an area where the home prices are out of control and most people around me are "house poor." Making fair money, but spending most of their income on their homes and working 2 or more jobs to make it. I'm not sure if this is the area to start a business that is cash only. I know of one OT/SLP owned practice in my area through a PT friend of mine, that does very well as a cash owned business. They see only pediatric patients and are apparently very successful.

(in reply to PamPT)
Post #: 7
Re: Private Practice without participating with insuran... - June 1, 2007 9:28:00 AM   
orthotherapist

 

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Joined: February 7, 2007
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Pediatrics is a different animal - parents are willing to pay cash to have their children treated but will be hesitant to pay cash for themselves.

(in reply to PamPT)
Post #: 8
Re: Private Practice without participating with insuran... - June 3, 2007 11:44:00 AM   
FLAOrthoPT

 

Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
even sicker on society is the amount people will pay for animals, watch how much equine PT can charge, and get.

(in reply to PamPT)
Post #: 9
Re: Private Practice without participating with insuran... - June 3, 2007 1:31:00 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
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Haven't heard of any cash, check, credit based success stories yet, at least in NY.

(in reply to PamPT)
Post #: 10
Re: Private Practice without participating with insuran... - June 3, 2007 1:55:00 PM   
goodlooks58

 

Posts: 456
Joined: October 22, 2002
From: CA
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People are paying $150 per tx and upto $250 depending on the time spent using...cystals. Yes, this cystal therapist has you lie down on a tx table and has different colored cystals she touches different parts of your body to heal. I got a pt. who went through this therapy and after paying $500 cash for 2 tx came to me for an MCL strain. I used her ins and got her better in 4 visits at $70 a visit.

(in reply to PamPT)
Post #: 11
Re: Private Practice without participating with insuran... - June 3, 2007 2:50:00 PM   
FLAOrthoPT

 

Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
i was chargin between 100-200 per patient, and had at least 4 pts booked a day, i was going to pts houses so i had very little overhead, a 165 dollar table, some towels. it was very easy, very lucrative, i just hated having to have the direct equation of me working = me making money, so i branched out to create residucal income even if i didn't work. but cash based businesses are VERY viable in the right area, with the right person, with the right marketing, with low overhead.

(in reply to PamPT)
Post #: 12
Re: Private Practice without participating with insuran... - June 3, 2007 8:44:00 PM   
PamPT

 

Posts: 20
Joined: May 1, 2006
From: Maryland
Status: offline
Thanks everyone. This is good info to think about. I thought there would be a good market in my area for lymphedema management. I also considered starting off going into patient's homes to lower overhead initially. I have a bit to consider and investigate.
FLAOrthoPT- did you not bill ins for your home visits?

(in reply to PamPT)
Post #: 13
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