Why is Mpwr PTW Cash based?

M Power PHysical Therapy and Wellness is a cash based physical therapy clinic which includes offerings for strength and conditioning as other wellness type services.  We do not participate with any insurances for a variety of reasons though more simply put: costs.

Let’s break down the cost of accepting insurance for you as a patient, a treating therapist, and as a business owner.

As a patient you likely accept insurance through a work provided health care plane, whether it is your own plan or a spouse/partner’s plan.  There is a premium cost to this plan that is taken from every paycheck.  Recently my wife and I looked into renewing our health coverage and found out that the associate and spouse premium was over 2.5x that of an individual plan and that the overall premiums had increased from the year before.  The lowest deductible plan offered is $2000.  Co-pays vary from $20-250 depending on the service being performed (primary care visit vs emergency room). Prescription coverage is also variable year to year and medication cost can vary year to year.  So right out of the gate I would need to spend about $4000 in healthcare fees prior to have insurance cover significant costs.  I admit there are a variety of health plans available that may offer better coverage but there are lso many more plans that offer even less.

A clinician’s salary is directly tied to the reimbursement provided by health insurances.  There has never been an increase in reimbursement, reimbursement always decreases.  As a result there is a greater expectation to see more and more patients because of the lower reimbursement.  Certain insurances place administrative hurdles in place as well which require more of the clinician’s time completing additional paperwork and phone calls to justify their care for your treatment which further limits how much time they can spend with their patients.

In addition a certain billing amount is expected per patient.  Some physical therapy codes reimburse more than others.  Most clinics in 2025 are charging approximately $350-$400 per visit as the expected insurance deductions are approximately 75% of what was billed

As a business owner, accepting insurance has significant costs, primarily in staffing.

 First, insurance require credentialing in order to be affiliated.  Some insurances only require the business to be credentialed while others require every clinician to be credentialed. This credentialing needs to be updated or renewed regularly as a result there is generally an administrative staff member who is hired to maintain this credentialing. 

After becoming credentialed, additional staff is required to acquire and verify your insurance benefits. This is usually done by at least two different staff members.  Insurance verification can be a troublesome process.  There are resources where your insurance information can be input and your in and out of network deductible, co-pays, and visit limits are provided.  However these services can be unreliable and the insurance company has to be called directly.  If you think that businesses have a shorter wait time on the phone you are very mistaken and that our staff who verify insurance get to sit on the phone waiting for a hopeful human to respond. After this struggle we then come to find out that some portion of the information was not accurate and the client/patient is reasonably irate and additional resources have to be used in order to address this issue.

Assuming the other steps have gone well we have at least 2 more staff members to consider. Every time a patient is seen a bill is generated that is submitted to insurance.  There is a primary biller who reviews the claims to minimize rejections and maximize accuracy and then submits the bill.  There is then a secondary reviewer who makes sure that we do get payment for all claims and notes any rejections and attempts to correct the billing issues in order for payment to be received.  Many insurance companies usually submit payment within 30-90 days however some can take up to a year. I am sure that as a patient you have received a bill weeks if not months after a service was provided, this is due to ‘timely processing’ by insurance companies.  

At last we have received payment for our services and one more staff member is used to match the payment to time of service and make sure any checks and electronic payments are correctly placed for bookkeeping purposes. 

Whew, what a ride.  And that’s just maintaining staff to take insurance.  Certain clinics and systems likely have some team members that dabble in a variety of these tasks however this can be upwards of 6 team members required to consider insurance.

Let’s consider how a business owner offers benefits to their staff with what we know so far.  An owner wants his staff to be happy, feel invested in, and provide some work life balance.  As reimbursement decreases  a business owner has to figure out how to lower costs while maximizing profit.  One way is to simply have their clinicians see more patients on a week to week basis, reducing work life balance.  Alternatively they could offer cheaper health insurance plans which usually means higher deductibles, higher premiums, and generally fewer services covered.

Let’s consider the community the clinic is trying to serve.  Maybe as a clinic owner I stop accepting certain insurances that carry higher administrative burden or with the lowest reimbursement.  This may allow me to reduce my total administrative staff due to less work but I also limit how much of the community can be helped.

Let's create a little story that I have seen play out more than a few times.

A patient comes in seeking physical therapy services for shoulder pain. The front desk takes down their insurance information and schedules the patient for a visit with the physical therapist.  The insurance verifier confirms the patient’s co-pay for physical services is $30 per visit and physical therapy services are covered at 100% after a $1500 deductible. The patient is seen twice a week for a month (8 visits in total) and pays their $30 co-pay each time.  About 1-2 months after discharge they call angry and frightened.  They received a bill for over $1500 and don’t understand why.  The explanation of benefits notes that the clinic charged approximately $400 per visit which the patient was fully responsible for as the deductible had not been met.  Also, the patient actually had a $35 co-pay thus additional funds were owed.

Alternatively maybe the insurance has ‘adjusted’ the bill to $180 per visit but the co-pays are still $35 and about $1500 is owed. Resulting in similar fear and anger.

All in all the costs of accepting health insurance cost you as a consumer more and more and result in overall fewer health care facilities who can properly staff and service the community they are in.

Let’s look at while M Power Physical Therapy and Wellness is Cash Based Only and does not participate with any health insurance. Again unsurprisingly the answer is costs.

When you as a client/patient reach out it is a clinician who will be interacting with.

Due to lower administrative costs our clinicians can have more time with you one on one during your session and can be more easily reached throughout the week via email and phone.

Our clinicians do not have to worry about specific billing codes to maximize reimbursement.  Their focus is you, your story,and your journey to recovery.

Due to our ability to stay one on one you will not be handed over to a clinic assistant/aide/tech to do exercises on your own that your therapist will bill for even though the services are not directly one on one.

If your aches and pains are recreationally related we can treat that whereas insurance would deny this coverage due to it not being a functional part of your daily life.

Due to our focus on education and individualization you may need overall fewer visits within your recovery period than you would in an insurance based clinic ultimately saving you time and money.  

Insurance based care usually limits you to being treated for one body part only at a time. Cash based services can permit the whole body to be treated however it must be noted that trying to treat too many things at once can be detrimental to any progress and emphasizing recovery on a body part of quadrant may be more ideal.

Certain insurances require referrals in order for services to be covered.  Some insurance require that these referrals be from a primary care physician and not a specialist.  Maryland is a direct access state meaning you can come directly to a physical therapy clinic for treatment services without a referral.

Overall the costs of cash based physical therapy services are directly passed to the client with superior service and interaction.  You as a patient/client spend less time trying to acquire the administrative work to begin PT, spend less time worrying about the cost of PT, spend less time in PT, and can spend more time on the things that matter to you.

If you have any questions regarding our cash based services vs insurance based treatment please feel reach out to us on our contact page with your questions.