An editorial by Ben Wobker, PT, MSPT, CSCS, SFMAc

A new phenomenon is putting pressure on physical therapists: skyrocketing deductibles and coinsurances that discourage patients from completing treatment. Medical expenses are at an all-time high, averaging $8,000 per individual annually. Much of this is comprised of deductible and coinsurance fees, which are much higher than simple copays. According to a recent report by the Commonwealth Fund, the average deductible increased 117% for individuals between 2003 and 2011; 106% for families. This presents a bigger patient communication challenge than asking a patient for a $20 copay and most PTs don’t know how to handle it.

Being a physical therapist is now about caring for our patients both clinically and financially. In order to keep patients in therapy, we must help manage their financial concerns. In order to do that, we must communicate transparently about what the actual costs for care will be — without discouraging them from pursuing treatment. And if we under-communicate, we risk having unhappy patients on our hands or worse—losing them altogether after they receive a large bill they didn’t see coming. At my practice, we’ve adopted a handful of tips which help us proactively communicate with our patients about coinsurance & co-pays.

  1. Start the conversation before the patient arrives at his or her PT appointment:

We send an email to every new patient with directions to our clinic, instructions for his or her first appointment (bring your health savings card, etc.), and a phone number to call with any or all questions. We also send information about copays and coinsurance so that everything is “demystified” before the patient’s first appointment.

  1. Don’t relegate payment conversations to the front desk & admin staff:

 Conversations about coinsurance and co-pays can (and should) happen between more folks than just the patient and front desk staff. They should also happen between PTs and referring physicians. For example, when a physician refers a patient to me for four weekly visits with a $50 copay for each, we’ll send a note back to the doctor that says, “You know what, we’re just going to have your patient come in once a week, because of the financial burden.”

By being transparent with the doctor about why we’re “ignoring” their referral instructions, we’re helping the doctor understand that out-of-pocket cost is a factor in PT care and patient compliance.

3.         Collect Toward the Deductible on a Per-Visit Basis

 I know I’ve had some doctor’s visits of my own where I see the lump sum in front of me and I’ve thought to myself, “Wow, $500?? If I knew that was the cost of  bloodwork, I wouldn’t have come in today.” This is what we’re fighting against in PT. By collecting toward the deductible on a per-visit basis, patients are         never overwhelmed by an unexpected $1,800 bill.

 While most clinics wait until the copay rolls up and deal with payments at the very end (which again; forces the tough conversation on your admin staff), we recommend staying on top of the cost by asking a patient to put the money forward at each visit. By billing “as we go” and communicating openly with the patient, it’s easier to assess the cost throughout treatment and make decisions about whether we need to restructure the patient’s PT plan.

We’re in a better position when our job is to reimburse the patient, rather than have our admin team running circles trying to collect large patient bills. There’s this odd myth in healthcare that since we’re here to help people, we probably won’t collect for bills. Because of this, there ends up being a lot of pro-bono work being done—which is obviously no way to keep your business afloat.

These three basic best practices help us manage our patients financially, beginning before the patients even step foot into our clinic. Undoubtedly, healthcare costs are set to continue rising: the most important things we as PTs can do are be mindful of our patients’ needs and communicate openly and honestly with them, both clinically and financially.


Benjamin Wobker, PT, MSPT, CSCS, SFMAc, practices at Lake Washington Physical Therapy, Kirkland, Wash. Wobker works as a clinical instructor for graduating physical therapy doctors from regional universities and as an advisor for local high school seniors. He has mentored doctorate physical therapists, college interns, and high school interns.