There are a lot of people who consider health insurance to be a necessary evil.

Insurance and government health programs and can be expensive and frustrating to use for both consumers and providers. However, when patients need medical care, they’re generally glad they’re insured. One of the first questions patients often ask is “Will my insurance cover this?”

At this point you might be saying something like my adolescent daughters used to say to me, ” Duh dad, everybody knows that.” Well, maybe because everybody knows it we are blinded to how much healthcare economics have changed.

One tactic of healthcare reform is to reduce total healthcare spending by shifting upfront costs to consumers. Yet many clinics still think because patients have insurance their practice isn’t functioning as a cash practice until deductibles are met.


Dependency on the insurance cash cow can lead to ignoring the tens of millions of Americans who are either uninsured, have high-deductible health insurance, or just want to escape from bureaucratic medicine altogether. There are thousands of consumers who want healthcare without an insurance company or governmental involvement. They reserve the right to choose their preferred provider with no outside influence.

There are therapists who are bypassing insurance companies too.

Therapists are setting up cash-only practices with the goals of spending more time with their patients and taking back financial control over their livelihoods. They cater to consumers who are looking for affordable medical care and expect to pay out of their own pocket for some or all of their healthcare.


Now the question is not ‘Will my insurance cover this?’ but ‘Whom can I trust to give me the best care for my money?’

This is where a cash practice makes the most sense. A cash practice is built from the ground up to serve self-pay consumers. As mentioned before until deductibles are met patients are essentially paying cash for the care they received.

The cash practice model comes in several names and forms. It’s sometimes known as self-pay, cash only or concierge medicine. Cash practices among therapy entrepreneurs are not a fad.

We are starting to see more self-pay clinics among primary care doctors too and there are some specialists are going this way, too. The growing trend of medical practices catering to self-pay patients is in direct response to economical and cultural shifts in the United States.

What are the big benefits for therapists?

Therapists leave the traditional insurance-based payments for the cash pay model for a variety of reasons. Here are a couple of the main ones:

1. Tired of the churn

Many therapists are fed up with factory-like therapy with its overemphasis on production and profit.

2. Frustrated with bureaucracy

PTs and OTs have grown tired of dealing with the bureaucracy of insurance. The endless stream of paperwork to comply with overreaching regulations has caused many therapists to look for different practice options.

3. Feel undervalued

Therapists are tired of fighting to get paid for what they feel they are worth. They see insurance payments for patient treatments as being ridiculously low. At the same time, they see their operating costs rising. The only solution some therapists feel is to work faster and see more patients,

4. Compromise quality

Therapists are seeking alternatives because they feel they are compromising the quality of the care and their professional self-respect.

5. Loss of freedom

Everywhere therapists turn outside forces are telling them what they can and can’t do. Increased regulations and employer productivity demands are stifling therapist’s growth and freedom. Not just their professional work but their personal lives as well.

“I’m mad as hell and I’m not going to take it anymore”


Therapist’s angst reminds me of the 70’s movie Network where newscaster, Howard Beale yells into the camera and tells his viewers to get up out of their chairs, go to an open window and yell “I’m mad as hell and I’m not going to take it anymore”.

Therapists all over the country have reached their breaking point. They are not going to take abuse from the insurance system anymore. They are mad as hell and they are going off the insurance grid.

That’s all good and well for therapists but we haven’t answered our initial question.

Are cash practices good for patients?

Cash-based practices can be a good investment, even for patients with insurance. Contractual requirements from corporate health plans have intruded into the medical provider-patient relationship. Obamacare with its more than 132,000 pages of regulations has added even more layers of red tape creating a bigger wedge between therapists and patients.

Patients experience this wedge when they have to fill out more forms and provide more personal information. They feel it when sitting in waiting rooms much longer than they do in front of a physician. They experience less time with the primary care providers before they are passed on to supportive personnel. They know they are paying more but getting far less.


What are the big benefits for patients?

1. Cost effective care

Therapists have the extensive education and training to be neuromuscular primary care experts. For the majority of patients’ with movement problems therapists are the provider of choice. For people with high deductibles, it makes financial sense to pay a therapist for a comprehensive evaluation and treatment. Fifty percent of Americans will experience some type of musculoskeletal episode each year. Skilled cash based therapists are a third-party-free alternative for self-pay patients.

2.  Accessibility

In most states therapists have direct access. Patients typically have a shorter wait times in a cash practice. Most clinical prediction rules state that the sooner the patient is seen the better the outcome. Let’s face it, patients are becoming impatient driving around town, filling out insurance forms wherever they go. The busier they are the less tolerate they become with poor customer service.

3. Transparent Affordable Pricing

For the self-pay patient finding therapists who offers fair, simple and transparent prices is crucial. Cash based pricing eliminates the added administrative costs when submitting claims to insurance companies. No more “We’ll send to insurance and see what they pay” when both parties know that the charges are coming out of the patient’s pocket.

4. Protected Patient-Therapist Relationship

 Imagine a practice where that doesn’t demand your insurance card and ID before they say hello. Imagine a practice where money doesn’t get in the way of patients getting to know their therapist. Taking insurance middlemen out of the equation allows therapists to present themselves as an empathic professional who understands the true cost of healthcare.

5. All Patients Are Welcome

All patients, insured or uninsured, in network or out-of-network are welcome. Payment is by cash, check or charge. Patients aren’t rejected because of their insurance carrier. Cash practices that are designed for self-pay patients are free from outside interference to address the circumstances and needs of individual patients.

The cash practice alternative seems to satisfy a growing appetite among consumers, especially those who are under 65 and not on Medicare. Today’s healthcare consumer has become embolden to know what care cost and are demanding more transparent pricing.  Just like they do in every other area of their purchasing lives they search online, compare, asks their friends before making a wise purchase.

There is a growing intolerance towards the hidden cost of healthcare. Practices that change their billing practices from the ground up to accommodate the self-pay client will be better prepared for the next generation of healthcare consumers.

My final question for you.

Are you so hung up in traditional third party reimbursement that you aren’t doing what’s best for your patients?

Paul Potter is a physical therapist and mentor who lives in Lincoln, Nebraska, with his wife, who is also a therapist. They have four daughters. For more than 35 years he successfully managed his own private practice.

He has authored On Fire: Ignite Your Passion with a Cash Therapy Practice and Cash Therapy Practice: Professional Freedom in the New Healthcare Economy. His website PaulPotterpt.com and his podcast Functional Freedom are dedicated to helping therapists build their dream practices. Connect with Paul on his website or on Twitter @lifetouchpt. You can also get more free resources at PaulPotterPT.com