Pelvic Floor Therapy and Insurance
- Feb 6
- 3 min read
by Erica Whaley, OT
When choosing between different pelvic floor therapy clinics, a common consideration is insurance coverage. It’s important to understand how insurance-based and cash-based care might differ so you can be empowered in your decision making when choosing what might be right for you.
What Does “Insurance-Based” and “Cash-Based” Mean?
An insurance-based provider accepts insurance plans directly and handles billing the insurance company on their own, often charging you for whatever co-pay your plan has designated at each visit. The insurance company reimburses the provider for their services based on what they submit for, using special insurance billing codes based on treatment type and time spent with the patient.
Cash-based providers take direct payment from the patient for the care provided at each visit, and then give the patient a superbill, or a breakdown of the billing costs for the insurance company. Then, the patient submits the superbill to their insurance company for reimbursement, and the insurance company pays the patient back based on their plan’s out-of-network benefits.
Insurance-Based Pelvic Floor Therapy Pros and Cons
In an insurance based practice, a benefit might be that you are often paying a co-pay based on the plan you have with your insurance, so the upfront costs tend to be lower. This might make it easier to budget for routine care. However, because the clinic is making money based on the amount of time and patients that they can bill the insurance company for, usually appointments are short, providers are frequently stretched thin across multiple patients at a time, and therapists are limited in what they can use for treatment strategies based on what insurance companies will reimburse for. In addition, usually insurance companies only approve coverage for a short batch of visits at a time, meaning that when those pre-approved visits have been used, re-assessments are required for additional visit authorization. This takes time away from treatment in a session, and may take weeks of review before you can resume care. And after jumping through hoops, some insurance plans might send the patient the bill anyway (like if you have a higher deductible that hasn’t been met yet) - it just comes later from your insurance company, and not from the therapy clinic directly at the time of the appointment.
Cash-Based Pelvic Floor Therapy Pros and Cons
In a cash-based model, the upfront cost might be higher. Coverage can vary widely based on your plan for out-of-network benefits, so it’s always recommended that you reach out to your insurance provider ahead of time so you can plan what will financially work for you. However, because your therapist doesn’t need to bill the insurance company for your care, there is a lot more flexibility in how they can treat. Oftentimes, this means one-on-one care, longer sessions, and no need to ask for authorization for more visits from the insurance company. Therapists are able to be more flexible and creative with how they provide care, too. For example, in pelvic floor therapy, oftentimes insurance companies won’t cover any treatment to the hips, legs, or back - even though these body parts are frequently huge pieces of the puzzle with pelvic floor symptoms (hello, leaking with running and chronic back pain!). In a cash-based practice, your therapist is able to address anything that they think will help your symptoms, regardless of what an insurance company might dictate.
In Summary
Though there are benefits to both models of care, it’s important to understand your insurance plan coverage and the differences in how care can be provided before you make your choice. If your plan has low co-pays and deductibles and you don’t mind potential restrictions, then insurance-based services might be right for you. If your insurance has a higher deductible or limited coverage, or you are looking for focused, uninterrupted care, then cash-based is likely best.
At Wellest Integrative Health
At Wellest Integrative Health, we choose to be cash-based so we aren’t dictated on how we provide care by insurance companies. We believe that being cash-based allows us to focus on the patient, so you can get personalized, holistic, and compassionate care that was thoughtfully made for you (and not for insurance approval).
If you have any other questions about cash-based therapy, or if you are in the Boston area and looking for a great team of supportive and knowledgeable providers, give us a call!