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  • Writer's pictureLuke Phillips

Do You Take My Insurance? 6 Reasons to Choose Cash-Based Physical Therapy Over In-Network Options



The quick answer is no, we don’t work with insurances. The long answer is this blog (I hope you keep reading!). My aim is to provide you with the reasons and rationale for why we chose to be a cash-based practice and the benefit it provides. I hope you enjoy the information as it has been transformative for me, our practice, and the lives of the many clients who we’ve had the pleasure of working with. 


In 2015, I graduated from USC, the top physical therapy school in the nation, with hopes and aspirations to change lives and improve the world by helping people move better, get stronger, and hurt less. Not long into my career as a physical therapist, I began noticing the corruption in the medical system. My grand desires were slowly being chipped away: arguments with insurance adjusters to get more visits approved for my patients who truly needed it; being forced by clinic directors to see more patients per hour to keep up with the reducing reimbursement (payment) rates of insurance companies; spending hours after work writing detailed medical notes to send off to insurance companies so that the clinic would get reimbursed for our hard work that day; and the list goes on.


As our treatment times with each patient became shorter and shorter, to the point that I was unable to provide the level of care and individualization that I felt my patients needed (more on this later), I soon found myself on the road to burnout. I dreaded going in to perform the work and be a part of the profession that I recently was so excited about! I was frustrated with the monster that was health insurance and the traditional in-network physical therapy model.


After six years of practicing in this type of setting, I reached a tipping point. I had relocated with my family to Idaho with the intent of opening up my own practice. But I was so frustrated with our profession that I wasn’t going to call it physical therapy. Rather, it would be focused on health and fitness and have a cool “fitnessy” name, focused on getting real people real results. No B.S. from bureaucrats behind a desk telling me what my patients needed or what we should be doing with them.


This took some thought, a lot of faith, consulting smart people, praying, and research, but I finally came to what is now Achilles Fitness Institute (AFI). In January 2021,  I jumped all in - quit a full-time job and started a clinic within two gyms. My mind and soul could finally breathe! I felt freedom to explore techniques freely with clients (oh yea, we call the people we work with “Clients” now, not patients. “Patients” sounds sick and injured). I now had the liberty to work unrestricted with all of the skills and ideas I had developed and partner with dedicated clients to help them achieve the goals they had been seeking! 


I developed the following mission statement: To provide proven treatment and training techniques to athletes and active individuals so that they can enjoy a high-performance life. Our AFI vision is to be the premier provider of musculoskeletal healthcare and therapeutic fitness training for athletes and active individuals. 


In order to make this kind of business thrive, we could either be the best at what we do and charge our clients for this top notch service, or fall into the high-volume low value game that the majority of physical therapy practices have adopted. I chose the former. If you want a Porsche, you buy a Porsche. You want a Dodge Dart, you buy a Dodge Dart. You get what you pay for and you understand what you’re buying. No offense is intended for those who drive Darts.


I truly love what I do and have brought on other like minded physical therapists and fitness experts to move our vision forward and help as many people as possible. 


Now that you understand a bit of our back story, below, I’ve listed out 6 reasons why cash-based physical therapy, like AFI, is a superior option for taking care of your body. 


  1. Quality Time and Individualized Attention

One of the primary advantages of cash-based physical therapy is the luxury of time. In-network providers often adhere to a tight schedule to accommodate the high volume of patients required by insurance agreements and low reimbursement rates. This can result in shorter sessions and less individualized attention. We call this kind of PT practice a “Mill.” You can see why. 



The final straw for me in a “mill” was when a friend’s wife came to see me for her hip pain. She was paying out-of-pocket for the session, so there was no insurance dictating how long to spend, or what to do with her. I was excited! But our office manager double booked her with another patient so that I only had 15 minutes of treatment time. Needless to say, she wasn’t pleased with the experience (nor was I).


On the other hand, therapists at cash-based practices like AFI, have the ability to spend much more time with each client. In our clinic, that means 60-90 minutes! This allows for a comprehensive assessment, personalized treatment plan, and a deeper understanding of our client’s unique needs. It is purely one-on-one attention each visit. 


  1. Tailored Treatment Plans

Cash-based physical therapists have the freedom to design treatment plans based purely on the client's condition, goals, and needs. Without the constraints imposed by insurance requirements, our therapists can employ a variety of techniques and exercises that are research-backed but may not be covered by standard in-network protocols. This tailored approach often leads to quicker progress and more effective results, as treatment can evolve in real-time to address the client’s changing needs. It is also much more enjoyable for the client to progress into higher level exercises instead of being stuck with resistance bands and table exercises. 


It is important to note here that many in-network clinics will base their treatments on what insurance will reimburse higher. We believe this is unacceptable and the opposite of healthcare. At AFI, we’ve eliminated the middleman. We like to say that we work for our clients and not for insurance companies.  


  1. Access to Specialized Services

This goes hand-in-hand with the previous point. In-network physical therapy often follows a standardized approach, only providing services that insurance companies will reimburse. You might need heavy weight lifting and sprint training to get back to sport, but insurance often doesn’t cover this, so you’re stuck with glute bridges and single leg balance drills. Or, following a major injury or surgery, you might need extensive manual therapy beyond what an insurance company thinks is necessary. 


In contrast, our cash-based therapists can provide specialized services, such as manual therapy, sport-specific training, strength & conditioning, or other innovative treatments that are not covered by insurance, or reimbursed at a low rates, and therefore, not done as much by in-network therapists. Clients seeking a more fitness-forward therapy experience may find greater satisfaction in the diverse options available through AFI’s  cash-based services. It is often found that individuals with more sport-specific and wellness related goals plateau with in-network care due to insurance deciding on when care is terminated as well as not receiving individualized care to include appropriate exercise dosing.


  1. Reduced Administrative Hassles

Navigating insurance can be a time-consuming and frustrating process. Billing, pre-authorizations, and claims can lead to administrative headaches for both patients and providers. Cash-based physical therapy simplifies this process, as there's no need to deal with insurance companies or worry about pre-approvals. Patients can focus on their recovery without the added stress of insurance-related paperwork or a “surprise” bill two months later.


I should mention that even with insurance coverage, you will likely have a deductible. This deductible must be met (paid) before insurance will kick in and pay for any medical care. So, if you are seeing an in-network physical therapist and haven’t met your deductible, you’re likely going to be paying not just your $40 co-pay each session, but the rest of the bill for that session as well until you meet your deductible. Paying cash for “mill” service may not be the best use of your hard-earned funds. 


  1. Long-Term Cost-Efficiency

While the upfront cost of cash-based physical therapy might appear higher than a co-pay for in-network sessions, the long-term benefits can outweigh the initial investment. Through personalized treatment plans, quicker recovery times, and reduced need for extended therapy, our clients can often achieve their goals more efficiently. This can lead to fewer overall sessions, ultimately resulting in potential cost savings over time. The cost of cash-based therapy is transparent at the first evaluation rather than worrying about co-pays and random bills later down the road. 


  1. Life-Long Health & Fitness

Have you ever finished physical therapy and wondered, “what do I do now?” Your knee or shoulder feels better, but do you just go hit the gym and hope it goes well? Do you get back into running like before? What about returning to sports? Who is there to help you keep making progress?


At AFI, we bridge this gap between injury recovery and high-level activity so that our clients receive the guidance they need to continue on their path of recovery, fitness, and sport performance. 


We aim to educate our clients so that they fully understand how to continue to make progress and build their body to be robust. Being out-of-network has allowed us to develop long-term training programs for our clients, long-term results, and long-term relationships.



We absolutely love what we do and look forward to doing it for a long time to come! If you are interested in receiving help at any point in your fitness journey (pain alleviation, exercise programming, sport performance), we would love to partner with you to help you along the way.

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