"Do you take my insurance?"...One of the first questions you ask any medical provider before your schedule your first visit... In Milestone's case, the answer is no, but this blog post is all about why our model delivers improved care, more personalized services, and will save you money in the long run.

5 Reasons Why Fee-for-Service Therapy is better:

1. Cost Effective Care

Even in an insurance based clinic, clients are responsible for co-pays and deductibles. These could run from $30 a visit to over $100 a visit for some of the highest deductible plans. These co-pays and deductibles are non-reimbursable by your medical insurance and are expected costs to you as the insured on top of what you pay each pay check. Additionally depending on what is billed each session, sessions fluctuate in price and coverage and the overall cost to the client is not up front, leaving the client feeling frustrated with a bill they didn't expect at the end of care.
In a fee-for-service model, all session prices are transparent, established up front, and do not fluctuate session to session. Based on the frequency of care and established plan of care length, a parent will be able to predict the cost of the therapy their child needs. Milestone does not believe in plans of care that "go on forever" and will determine meaningful goals and work toward those in an episode of care. Much of the time you can expect some reimbursement from your insurance provider for the out-of-network service or for the fees to be applied toward your out of pocket or deductible. We strongly recommend calling your insurance company to find out the process, find out if you need pre-authorization for therapy, and what the coverage might be. Milestone will work with parents who ask through the initial self-submission paperwork and will provide parents with a detailed invoice with the appropriate codes needed for reimbursement through their insurance company. Also, the sessions are able to be paid with your health savings account or flexible spending account if you have an insurance plan with that option.

2. Improved Client-Therapist Relationship

In insurance based clinics, many times the insurance companies dictate what they think to be appropriate frequency, appropriate services, and appropriate duration of care. Insurance companies may also dictate what they think to be an appropriate medical diagnosis for treatment and decide to not cover certain conditions that significantly affect your child's ability to function in the home and community. Many of these standards are set arbitrarily by individuals that have no experience with pediatric physical therapy and no knowledge of what is truly appropriate to address a client's deficits and meet their goals. Many times, providers will end up spending long hours attempting to get their reimbursement through insurance, and often, reimbursement is low or not provided. This takes away from valuable time the provider could be researching your child's condition, taking continuing education to improve their professional knowledge and skill, or working on other important services to provide clients. Other times administrators are hired to help facilitate the process which increases overhead costs resulting in the need to see more clients each day, decreasing one-on-one quality time with the therapist.
Because Milestone is a fee-for-service model, Dr. McIntyre can develop an appropriate plan of care with appropriate length and frequency to meet the needs of the client. One-on-one quality time is provided with time for question and education sessions for the parent to carry over newly formed skills into the home/community. Services can also be offered in a variety of community settings including your home, the playground, gymnastics lessons, or other activity without worry of approval by the insurance company. As necessary, Dr. McIntyre can also engage in consultations with other professionals involved in your child's life, including teachers, coaches, and other health care providers to work on establishing a more complete plan of care to address all concerns for your child.

3. Accessibility

In insurance-based clinics, getting an appointment can sometimes take weeks, months, and or even a year before the next "opening" comes along. Many times clinics have to keep themselves this busy with decreased discharge rate in order to meet productivity standards set by their establishment. Without the ability to tailor their plans of care to specific needs of the client, many times progress is slower and carry over into the home or community is decreased. Providers are also unable to set aside time to have sessions in the community or consult with other necessary care providers secondary to their productivity standards and traditional insurance based approaches to care. Also, many providers are tied to the hospital with inconvenient hours that do no include before or after school/work hours to accommodate clients and parents.
Because Milestone is a fee-for-service clinic, Dr. McIntyre's case load is smaller and has more flexibility in her schedule. Dr. McIntyre is able to offer a wide variety of hours to accommodate a client's schedule. Dr. McIntyre can typically offer an initial evaluation with in a week of a parent calling. Milestone is a functional-based clinic with priorities set on helping your child engage as fully with the world as possible. Because of the fee-for-service model, Dr. McIntyre can also integrate sessions into the community without worry of productivity standards or the times the clinic is "open" and is then able to provide necessary care for your child to meet their goals. Dr. McIntyre is also available by phone or by email to her clients throughout the week if there are concerns or questions and will go the extra mile to research topics and send informative information back to the parent in a timely manner.

4. All Clients Are Welcome

In an insurance based clinic, after the initial evaluation, they may determine your child's needs are not medically based or necessary and therefore not coverable by insurance or a priority for care. Parents are left feeling frustrated that there is "something wrong" but because it is not seen as medically necessary, care is not always provided. In insurance based-clinics, clients may also be turned away if they have insurance that is not accepted by the clinic.
Because a fee-for-service clinic is not guided by insurance mandates, any client who is referred for gross motor concerns, if deficits are found, is a candidate for therapy at Milestone. With new research coming out in recent years regarding the importance of gross motor skills in the development of peer interaction, confidence, and even school performance, even the mildest gross motor and coordination delays are important to address as much as the most obvious delays are. Each child should be offered their best shot at functioning as optimally as possible in their world! No matter what your insurance, Milestone won't turn you away from care.*
*In the case of individuals with Medicaid primary or secondary insurances, there are certain rules and regulations when it comes to providing covered services to Medicaid subscribers when not participating with Medicaid. At this time Milestone is not treating clients with Medicaid insurance coverage to protect both the client's and Milestone's interests.

5. Monthly, Bi-annual, and Annual Check-Ups

This type of service is not typically something provided by insurance-based clinics as it does not follow the traditional model of physical therapy. Either clients are discharged after a set amount of visits and deemed "cured" or clients linger forever attending therapy once a week until the end of time because they fear they will be unable to get back into services if they do a take a break. But breaks and episodic care are important to both the child's attitude toward therapy, the family's and therapist's need for a break, and often allows the family/child to focus on other important aspects of their health and well-being.
As physical therapy has developed into a Doctoring profession and become the Movement and Mobility Experts in the health field, the need for check ups of some frequency has become of an ever increasing importance. As we strive to optimize the prevention of injury or in a child's case in the promotion of development, physical therapy has grow to fill this need. We see our family care doctors and even our chiropractors for annual check ups and tune ups... why wouldn't you also see your physical therapist for the same thing especially after you have become an established client? Catch an issue before it's a problem and decrease your health care utilization in the long run!! As of now, insurance companies do not cover this sort of service despite its importance in overall health care. At Milestone, every client that has completed their current episode of care will be scheduled for a check up visit 3-6 months afterward to make sure all goals are being sustained and new issues have not arisen, if all is going well the check ups continue in the same manner. This approach to a lifetime of care for children who will understandably need a lifetime of services makes sure each child is monitored for gross motor development and that intervention is delivered when most appropriate!

Now, fee-for-service care is not for everybody, Dr. McIntyre understands this, finances have to be kept in consideration. She tries to keep her costs fair to the client and all costs are based on average current insurance reimbursements (in a perfect world where they actually pay you what they say they will!). For families that are looking for personal service, one-on-one quality attention and care both during your visit and in between visits, and the ability to integrate therapy into the community or home setting, this type of model can offer that and much more for you and your child.