MATTERA
PHYSICAL THERAPY
FAQ
What is a cash-based physical therapy provider?
Cash-based simply means that I do not accept traditional health insurance and therefore, require direct payment for all services rendered via cash, credit card, cash apps, health savings account (HSA) or flexible savings account (FSA).
Why don't you accept insurance?
The main reason is that it allows me to provide high quality, one-on-one care and practice autonomously. I only treat one person at a time and you will see me for the entire session (as opposed to being supervised by a rehabilitation aide). I also see clients at a lower frequency (ideally 1x/week) compared to 2-3x/week at other insurance-based providers. Insurance companies continue to offer lower reimbursement rates for PT, which makes it more difficult for clinics who are not seeing patients in higher volumes to actually turn a profit.
The second reason is to streamline the process of getting in to see me. Massachusetts has "direct access" which means that you can go directly to a licensed PT provide without first seeing your doctor for a prescription. Still, many traditional insurance companies often require an MD script or referral in order to reimburse for therapy services. This means more time spent by you going to appointments prior to seeing me, more time spent by me on paperwork, and therefore less time spent with you. Patients can see me when they need it and without delay.
Can I still get reimbursed through my insurance company?
Possibly. You can use your HSA/FSA account if you have one, as we are a covered medical service. In the future, Mattera Physical Therapy plans to offer out-of-network benefits. If you have out-of-network benefits (check your plan) you can submit an itemized list of the CPT billing codes used during treatment to to your insurance company and potentially get back an amount that they would normally reimburse for each service, which is usually a fraction of its value. These reimbursement rates will vary based on your benefits, deductible, etc. and are not guaranteed. You will still need to pay out-of-pocket to Mattera PT at the time the service is rendered.
What is the cost difference between cash-based and traditional insurance?
If you see me for a PT evaluation and 5 follow-up visits, this will cost between $575-$650. Insurance plans vary greatly, but a few different scenarios can be considered.
1. Deductible plans. Common deductible amounts are between 2,000 to 5,000 for an individual, but can be more or less for both individual and family plans. An individual needs to meet their deductible and therefore will need to pay out-of-pocket for services, which may be billed at a higher rate. The goal of Mattera PT is to see you less often, but to spend a greater duration of time per session one-on-one and therefore, decrease out-of pocket expenses. 5-6 visits total will likely cost less overall than 2-3 visits per week for 4-8 weeks with a deductible plan.
2. Co-payments. Co-payments also vary greatly, but are usually within the range of $20-75 dollars for a specialty visit. Two sessions per week for 6 weeks at $75 per session will cost $900. You can do the math using your co-pay and compare them to my current rates.
3. Co-insurance. Co-insurance means that your insurance company will pay a percentage of the service, but then the patient is responsible for the remaining percentage. It is common for the patient to be responsible for 20% of services, while the insurance company pays the other 80%, but it can vary. You may need to meet a deductible prior to taking advantage of the co-insurance benefit.
Are there any patients that you CAN'T treat?
Unfortunately, yes. Physical therapists can't simply opt out of billing Medicare for services rendered. Mattera Physical Therapy can't legally take cash from a Medicare or Medicaid patient for covered services (physical therapy). We can accept payment for non-covered services (ex. strength training and maintenance tissue work).
Do you do payment plans or package deals?
Yes! Just ask.
Will you go to the patient at their home, office or gym instead of them coming to your office on Newbury St.?
100%. I strive to offer the most convenient and accessible PT experience possible and have no problem traveling to you if the distance is within reason. I will also allow a gym or event to essentially buy my PT services for a pre-determined block of time where I can evaluate and treat as many individuals as that time will allow. All concierge services are priced on a case-by-case basis and will require a phone conversation or email to discuss prior to booking.