Concierge medicine is a newer development of healthcare. Although many of us who are employed have health insurance, and pay for this out of each paycheck, it can be incredibly puzzling why when we go to use this benefit, why many providers are no longer accepting insurance. Why is that?

When a provider is tied to an insurance company, we must modify our interventions based on what the insurance company wants to pay for. They reimburse for certain tests, measures, assessments, and procedures that are evidence based in nature. Many times, individuals do not benefit from these protocols, but it is necessary to provide this data in order to get reimbursed for the patient’s visit. It also does not pay for certain interventions that may not currently be evidence based, but have so far shown very promising results. For example, certain insurances require that our primary care provider is unable to order any imaging. They require that we see a specialist to write this script. Even so, although there is little to no evidence that an x-ray would be able to identify the culprit of the pain, it is protocol to always have an x-ray prior to a CT scan. These added visits and added preliminary steps end up costing the patient, and the healthcare system, more time and money in the long run. This causes the patient to be in agony, unsure if they should still be using their injured body part or following the RICE protocol (rest, ice, compression, elevation). By the time you are able to see the specialist who can order the CT scan, you’re nearly 2 months in, all because your insurance dictates what must happen in order for you to get your healthcare visit covered. Once you are finally given the referral to PT, the clinic takes an additional several days to verify your benefits due to the front desk staff spending hours on hold with the insurance company, and then it takes an additional 2 weeks to be scheduled at the clinic.

In addition, based on the diagnosis, insurance then dictates how many visits they will be reimbursing the provider for, regardless of the chronicity of the injury, comorbidities, or lifestyle habits. For example, they will reimburse a provider for 5 visits of PT only for a child who presents with torticollis and plagiocephaly whether the 3 month old child developed this condition just 1 month ago, or the child has had it from birth and is now 2 years old and also has a diagnosis of Down Syndrome. Retraining the muscles, ligaments, and habits will require extensively more time, and therefore PT visits, for a child who has had 2 years of ‘practice’ of this posture. This in turn delays the continuity of care due to the provider having to block off time that should be spent on patient care to write and submit justification as to why more visits are needed and negotiate how many more visits insurance will pay for up front before requiring additional documentation to justify these ongoing visits.

In concierge medicine, the provider elects to not utilize insurance so that we can see you sooner, implement techniques that we know work for our patients, and return you to your baseline level, in a fraction of the time. Would you rather spend a few hundred dollars less and live with the guilt and anxiety about your child’s condition worsening after 2 months of waiting, and not knowing if what you’re doing is helping or hurting their development? Or would you rather see the physical therapist immediately and be taught what to do and what to avoid based on their diagnosis, and spend some extra money? Time and quality of life are in the moment and can never be regained. Money can always be replenished. Why put yourself through agony and waste your time when your child could be meeting their milestones in ~75% less time? That, in a nutshell, is why Moving & Grooving Pediatric Physical Therapy does not accept health insurance.

If your child has a condition that you would like to get addressed immediately, evidence has repeatedly shown that early intervention saves time and money in the long run. The longer we practice a behavior/posture/movement, the more it becomes permanent, not perfect. If your child has an injury, demonstrates a strong side preference, has no tolerance for tummy time, crawls with one leg out to the side, bottom scoots, tilts their head to one side, or walks on their tiptoes, everyday that they are able to continue this pattern means more days of rehabilitation to return them to the baseline where they need to be. I cannot tell you how many parents have told me ‘the pediatrician told me to wait and see, and it’s been 6 months and nothing has changed,’ so now we have to account for 6 months of delays rather than a few weeks, requiring more visits in the long run. Don’t let your health insurance prevent your child from getting the care they need and deserve. In 95% of situations, Moving & Grooving Pediatric Physical Therapy can get your child in for an evaluation within 48 hours, which also includes a home exercise program (HEP) that includes activities/ stretches/positioning that you can implement immediately to help your child meet their motor milestones. If your child is seen for a condition close to when they started to develop it, they will require exponentially less visits, time and cost to get them to where they need to be.

Are you wondering if your child’s condition requires immediate assistance? Text or call for a free consultation.