Why don’t we take your insurance?

‘Do you take my insurance?’ is the most common question we get when new clients reach out to Peak Pelvic Health. Many of you reading this probably asked that very thing when looking for a pelvic floor therapist. It is a great question, but the answer is more complicated than just saying yes or no. We wanted to share our reasoning behind why Peak Pelvic Health, and many other physical therapists are moving away from contracting with insurance.

Mallory started working as a pelvic health physical therapist right out of PT school, following multiple clinical internships and in-depth experiences in the pelvic health specialty. Her first job was at an orthopedic clinic that accepted insurance and offered pelvic floor therapy as an additional service. In fact, all of our therapists at Peak Pelvic Health have worked in a place like this before. To see the pelvic therapist in a clinic like this, patients walk through a busy gym with clanging weights, 80s rock music, and other patients looking on while riding the exercise bike for the 10th session in a row without knowing why, until they finally arrive in the back corner of the clinic where the pelvic floor treatment room is located. After a rushed 30-ish minutes with the pelvic floor therapist, you get dressed again, and are told to return to the chaos of weights, rock music, and exercise bikes while an aide scrambles to find your exercise log and follows the same protocol of bridges and kegels you did last week. 

We wanted to offer a different experience than this. We wanted to create a place where patients can seek expert care in a calm environment, and have a chance for someone to finally listen to them. Most physical therapists have this same ambition and desire to help people when they start their careers, but the unfortunate reality is that it is not possible to offer this with the barriers that insurance companies have set up for us. Let’s break down some of these barriers:

1. To specialize in pelvic health, physical therapists go through hundreds of hours of extra training and mentorship. They also use a trauma-informed approach, lead with empathy, and help people with some of the most sensitive issues out there. However, the insurance billing codes are no different for pelvic floor therapy than standard PT codes, and there is no difference in what a clinic would get paid for treating someone with an ankle sprain versus chronic pelvic pain and urinary incontinence. Therefore, to stay in business, the pelvic therapists are typically held to the standards of shorter appointments and larger volume of patients. The other part of the problem is that the dollar amount reimbursed to clinics is set by a governing body called CMS (Centers for Medicare Services). Each year, the reimbursement rates of treatment codes are voted on and these rates have been steadily decreasing over the past 20 years. This is detrimental to any physical therapy private practice that relies on insurance contracts. See the graph below for the reality of this: 

2. Denials when treating other body parts: Pelvic floor dysfunction can incorporate other body parts such as hip, foot, spine, and neck issues. If your Pelvic PT understands this and documents treating other body parts, sometimes they are denied and not paid because the body part was not on the referral. We feel that our clinical judgment should be worth more than what a claim adjuster with minimal medical knowledge decides for you. 

3. Insurance will not pay for any in-network care until your deductible has been met. This is especially important to know for those with high-deductible health plans. The most common health insurance plans have deductibles in the range of $3000-$6000, which you will be responsible for paying an in-network clinic a cash pay rate until this has been met. The worst of this has been highlighted by patients seen at our local hospital systems. They can charge you upwards of $500 for a 45-minute PT session, depending on your insurance plan (Yes, we are shocked too! If you don’t believe us, do a little digging in the reviews section). Even if you think you're just paying a co-pay at an in-network provider, you might get surprise bills in the mail months after the fact. We prefer transparency, and our average patient pays less than half of what their deductible would be for their entire plan of care with us.

So with that being said, here are the big ideas of what we can offer without “taking” your insurance:

Access

Most in-network clinics that offer pelvic floor therapy book out new patients 3-6 months, or might not be accepting new patients at all. We can typically get new patients scheduled within 2-3 weeks, and you can come directly to us! No pre-authorizations, no referrals, no visit limits, no co-pays, and no one sitting in a claims department telling you what you can and cannot do! 

Comprehensive Care

We offer hour-long appointments so that we can get to the root cause of your symptoms. We also put an emphasis on integrating multiple body systems into our care. Too often, we see people who have been dealing with chronic hip pain or constipation and do not know that their pelvic floor could be part of the problem. If your back hurts while picking up your kids, we will incorporate core strengthening and lifting mechanics into your treatment. If you experience painful periods due to endometriosis or PCOS, we will provide visceral treatment for your organs. If you have underlying hormonal imbalances in perimenopause, we will provide you with the resources to get this checked and properly managed. Many of these details are not covered at clinics that accept your insurance. 

Clinic Atmosphere 

We want to have a space where our patients feel safe to share their story, and where they can find long term resolutions to their symptoms. All of our sessions take place in a calm, quiet treatment room specifically designed for pelvic floor therapy. From the minute a patient walks in, they should be noticed, respected, and confident that they have come to the right place. You won’t find anyone riding the exercise bike unattended for 20 minutes here! 

Expertise

As we mentioned earlier, many clinics that offer pelvic PT do it on the side of traditional orthopedic treatment. This does not mean that you won’t find a good therapist at an insurance based clinic, but you likely won’t see the same person consistently, and they probably don’t have enough time to offer everything you need. It’s not their fault, but the patient care experience is dramatically different. At Peak Pelvic Health, Pelvic PT is all that we do! Our therapists have gone through extensive continuing education, courses, and conferences, and we regularly meet with each other to improve clinical skills. We do this because you deserve the best. We want to raise the standard for what pelvic floor therapy is in Colorado Springs. 

As many current and past patients can attest, your experience at Peak Pelvic Health will be different. We hope that this information helps future patients also understand that just because a clinic accepts your insurance, it does not mean it is the best investment in your personal health. While we do still offer ways that our patients can get reimbursed by their insurance providers, we feel that our model is the best way that we can provide the care that our patients deserve.