Physical Therapy cost at hospital vs private practice

The hospital systems DO NOT want you to know this…

I’m going to let you in on a secret that the hospitals will never tell you upfront.  It hits them where it hurts, their money.

Ok here it is…

Physical Therapy will cost you MORE MONEY in a hospital setting.

It’s plain and simple.  If you seek Physical therapy in a private practice, you will pay significantly less than if you were to do the same exact thing at a hospital.

Hospital systems have more leverage and are able to negotiate better contracts with insurance companies. This becomes expensive for YOU.

For example, Insurance may reimburse HealthSpan $25 for a service, and may reimburse the hospital $40 for the exact same thing based on their contracts.  If you have not met your deductible, that charge that was $25 toward your deductible (private setting)  is now a $40 for YOU at the hospital PT.

There is another way these contracts become expensive for you.  Some of them have caps on daily charges. This cap is not always the case with hospitals (or they may just be higher).  

For example this, I’ll use easy numbers for sake of understanding.

Let’s say you go to a private practice PT session, that PT can charge whatever amount they want to the insurance, but in the long run the amount doesn’t matter because their contract says they will pay a maximum of $100 for a session.  

So the PT may charge $500, but the insurance says “no, here’s $100 per your contract”.

But in this example lets say you haven’t met your deductible so that appointment is your responsibility.  Most contracts would say that the private practice PT can still only charge that patient $100. Fair enough right?

This isn’t always the case with the hospital system.  You may get that $500 bill because their contract doesn’t limit them!

I’ve personally seen bills sent to patients that were nearly $500 from a hospital that would have only been $70 at our clinic for the exact same thing

We’ve also seen a lot of copays being higher for a hospital setting lately.  For example, one insurance company lately has a $40 copay at a hospital setting, and a $10 copay for a private practice.  A quarter of the price! (screen shot below of actual quote)

Actual screen shot of insurance coverage quote done for a patient.

You think the hospital is going to tell you “hey your copay is $40 here but if you go down the road to a private practice it will only be $10”?  I DON’T THINK SO!

There are other things that play into their increased costs as well.  Hospital systems are able to charge more due to claiming higher overhead costs as well as charging a higher facility fee.

One last point that I will make is that hospital systems are more expensive because they are less informative (at least less informative than HealthSpan PT is).

For example, we try very hard to discuss coverage and patient responsibility at your very fist appointment as well as keep a close eye on reimbursements as they start to process.  This allows us to make cost conscious decisions about your plan of care and makes you aware of any costs you may incur up front.

In my personal experience this has NEVER been the case for any situation at a hospital.  You simply go, get the care, and hope the bill won’t be too bad when you get it in the mail a few months later.

Moral of the story, be informed and ask questions!

Request An Appointment!