Physical therapy practice posts fees

Anyone who provides your health sooner or later will need care.

Ever wonder if your doctor, nurse or therapist becomes frustrated when they ask how much a service will cost and get answered with a shrug?

“You try to find out these prices ahead of time and you can’t,” said Nancy Alexander, whose quest for an upfront price on an MRI a couple of years ago ended up changing how she practices physical therapy.

“If I want to do this right, I want to have people know what to expect,” said Alexander, 55, who recently started Achieve More Physical Therapy in Canandaigua.

Alexander posts prices for physical therapy — $135 for an evaluation; $90 for a one-hour follow-up and $48 for a half-hour follow-up at her clinic.

The business is cash-based, meaning patients are responsible for the entire price of treatment. Achieve More is not part of an insurance network. However, Alexander will provide an invoice for patients who want to have the amount applied to their plan’s out-of-network coverage.

Alexander has yet to have a physical therapy client. She also is a certified personal trainer and offers wellness education, specializing in people older than 50, and she reported having several clients for those services. She posts hourly rates for training, but so do others. It’s the physical therapy pricing that seems unusual in the era of high-deductibles, when it’s still unusual to find a provider who’ll help consumers figure out the cost ahead of time.

Pricing information has become part of Alexander’s marketing plan, with rack cards announcing the fee schedule. She said a health savings or flexible spending account can be used to pay the bill.

Providers such as dentists have had cash-based practices for years. The model is increasing among physical therapists, according to the American Physical Therapy Association.

Providers feel stymied by narrow insurance networks that have fewer practitioners, and what providers perceive as delays in payments from insurers, according to Elise Latawiec, a physical therapist and senior specialist of practice management for APTA, which is based in Virginia.

Latawiec didn’t have the number of practices that have converted to cash or that have started without an insurance contract, but said the association has been hearing of more in the past few years.

Alexander has worked full time in home care and continues part time. She said fees at Achieve More are less than what they would be if she had an insurance contract. She said she set her prices after checking Fairhealth.org, a national nonprofit that collects and shares data on medical and dental claims from commercial insurers.

Providers who cut the insurance cord may have more freedom to run their practice, but that has its own cost.

“You no longer have an insurance directory where people are going to pick you up,” Latawiec said. “You have to rely on word of mouth. If you’re not providing a service that’s valuable and people pay for it and they’re not happy with it, they won’t come back and they won’t send their friends.”

Latawiec said that providers with a cash-based business and who aren’t working with insurance have an obligation to tell consumers what they’ll pay.

“It’s like going into a store,” she said. “You want to know what you’ll pay for that dress.”

That's the crux of the problem with deductibles. Latawiec pointed out that the Affordable Care Act calls for openness from insurers, but that relates to clear language about what's in a policy rather than what the consumer pays for services under that policy.

Insurers don’t seem to appreciate that anyone with a deductible plan is a shopper who is looking for information about price. Insurers should embrace that value-conscious consumer because every dollar their members pay toward a deductible puts the insurer a dollar closer to having to kick in its money — actually money from you, me and the rest of its subscribers — to pay the bill.

“Insurances are saying, ‘Consumer, you need to be more responsible, you need to make the right decision for your health care,’" Alexander said. “But we don’t have the information yet. It’s like the cart came before the horse. Fine. We’ll be responsible. But we need information to make the right decision.”

Asked about other providers who offer well-defined services — an hour of physical therapy, an X-ray, the MRI that started this whole thing — Alexander said, “it’s a leap because there’s a system in place.”

As for changing a system as involved and complex as health insurance? “It’s hard to change a system when you don’t know where the change needs to happen,” Alexander said.

Patti Singer is the Clean Living reporter for the Democrat and Chronicle. Contact her at PSINGER@Gannett.com or (585) 258-2312.