Cash vs Insurance: PT made Simple
Ever felt like your medical bills don’t make sense, even though you have insurance? You’re not alone. In today’s healthcare system, patients have become independent consumers of their own health. They choose who they want to see and when they want to see them. This makes it ever more important for you the consumer to understand what you are actually paying for when you enroll in your employer’s health insurance plan or when you purchase a plan independently because of the Affordable Care Act. Depending on the plan you invest in you may be paying more money upfront or likely will pay it on the back end when you schedule an appointment with a healthcare provider. From premiums, to deductibles, to coinsurances and copays, it often becomes difficult to navigate the insurance model. Likely between paycheck deductions and what you actually pay when you see a provider, it is a lot more than you anticipated.
Why Paying Upfront for PT Can Save you Money
At Finish Strong, we believe in transparent, affordable care. That’s why we offer flat-rate pricing - NO hidden fees, no billing surprises and one-on-one care every time. Compared to insurance-based costs, paying upfront can actually save you money while giving you the freedom to prioritize what really matters: your recovery, your performance, and your goals.
Understanding insurance is empowering but so is choosing care that values transparency, quality and results. Let’s breakdown the different terminology regarding your health plan so you can become even more independent when choosing the right care for you.
Premium – A premium is the amount of money you or your employer pays each month to keep you covered or insured each year. Often times, the employer will pay a premium and a portion of that premium will be deducted from your paycheck. In 2024, the average premium for an individual insurance premium was $8,432 and family coverage was $23,968.
Deductible – A deductible is the amount of money you have to pay your healthcare provider before your insurance starts picking up the bill. This means, if you have a $5,000 deductible, then you will have to pay the first $5,000 dollars of your healthcare bills before the insurance starts paying. The exception is usually your annual physical in which your insurance will cover. In general, the higher the premium, the smaller the deductible. Most plans are moving towards higher deductibles in an effort to keep the premiums down.
Coinsurance – Once you meet your deductible, coinsurance kicks in. This is the percentage of each bill you’re responsible. Yes, that’s right! So you have a premium which comes out of your paycheck, then you have a deductible, which you have to pay prior to your insurance covering your bills, and then some individuals will have a coinsurance which is usually a percentages of the bill. For example, you may have a 20% coinsurance. If your bill to see a provider is $200.00, then you will have to pay $40.00 in additional to everything else you have already paid.
Copay – A copay is the amount you pay each time you see a medical provider. Depending on your plan you may have either a copay or coinsurance, or a combination of both depending on the service. Copays can range anywhere from $5.00 to $150.00. Every insurance plan is different.
What You Really Pay for PT Care – With premiums coming out of your paycheck and out-of-pocket costs stacking up at each visit the “covered” part of healthcare can still be expensive. When it comes to physical therapy, it’s important to understand how billing works. Insurance-based PT visits are billed in 15-minute units (and if a session hits 8 minutes you’re charged for the full unit). A typical session includes 3-5 unites, with each unit ranging from $40 - $80. That means a single appointment can cost anywhere from $120 - $400. If you have a high deductible plan you’re paying most of that.
Take Control of Your PT Experience and Costs
Navigating healthcare costs doesn’t have to feel overwhelming. With a clear understanding of your insurance and a trusted partner in your corner, you can make confident decisions that put your health first. At Finish Strong, we’re committed to providing a seamless experience with transparent pricing and personalized treatment. Ready to take control of your care? Book a session today and see how simple, predictable physical therapy can be.