What’s with all the self-pay medical professionals out here?

Submitted by lilfoodiebooty t3_yxybjm in StamfordCT

I have noticed that a lot of physical therapists, counselors, and psychiatrists are self pay out here. God help you if your insurance has no out-of-network coverage. I know insurance is a pain in the ass but the proportion of self-pay to insurance taking providers seems unbalanced. I’m all about compensating people for their services but this is nuts.

One physical therapist said they charged discounted rates for PT. Self pay was $185 - $250. Mental health providers are charging similar rates. Are people really out here paying $200-$300/visit for what are often weekly services?

What’s the deal? I’m still looking for a psychiatrist to manage my ADHD but all the ones my doctor recommended are self pay. We just don’t have money to burn like that.

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veridicus t1_iws5n46 wrote

Think of it from the professional's point of view. There's a lot of overhead to manage all the various insurance providers. Only a group provider can do this with any efficiency. And insurance companies negotiate hard to pay them as little as possible.

If a professional can work independently and let their customers deal with paying out of pocket or submitting out-of-network insurance coverage, why not? If they weren't getting customers they would go to the insurance providers.

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ruminas t1_iwsqr3w wrote

I know a LOT of insurance carriers have incredibly low rates so many companies that are smaller simply have to stay out of network, and that kind of model works in Fairfield County where there is a larger affluent population, though it obviously unfortunately affects the other large population of people who can’t afford self pay rates

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lilfoodiebooty OP t1_iws636k wrote

I sympathize and understand that managing insurance can be challenging. That doesn’t make it any less frustrating when you’re looking for care. I don’t have out-of-network coverage so I’m super limited and the ratio of these types of providers seem unbalanced. I have lived across the country in both populated and lower populated areas and have never seen anything like this before. Even my small surburban hometown had a doctor folks traveled across the country to see and he took insurance. shrug

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DLFiii t1_iwrs3qy wrote

I’ve never found a provider of any kind that was self pay only, and I’ve had a lot of ortho issues so a lot of PT. Also my primary and dermatologist all bill my insurance without issue. Maybe look around a bit more? I can’t speak for mental health services, but PT is plentiful and they will bill.

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lilfoodiebooty OP t1_iwrsrpk wrote

Fortunately, I found a physical therapist no problem after seeing an orthopedic surgeon at HSS. They have an awesome sports rehab. But even the doctors there said that it can be hard to fir PTs who take insurance. For a separate issue, I was specifically looking for a pelvic floor therapist and they were all self-pay. I looked for weeks and gave up. I have to go to Norwalk and had to have my orthopedic doctor find them for me.

General PT may not be so tricky but for specialties like pelvic floor physical therapists, psychiatrists with subspecialties, and MHP, no dice. I’ve never seen anything like this in other places I’ve lived.

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DLFiii t1_iwrtn91 wrote

That’s so strange. You might need to go into Manhattan with more options? Certainly most of the large systems like NYU or Sinai would have those subspecialties and I can’t imagine they’d be self pay as part of the larger organization. Good luck!

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lilfoodiebooty OP t1_iwru8zl wrote

While those are viable options, I should be able to find quality care in my own community. Going into the city isn’t always convenient when I have to work full-time. It would be great to go right after work or during lunch. Again, it’s not that they don’t exist in Stamford, they just do not take insurance.

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well-okay t1_iws630u wrote

If you’re looking for pelvic floor PT, that is available through Stamford medical group in the hospital and they do take insurance.

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PikaChooChee t1_iws8zvo wrote

Indigo Wellness has pelvic floor PTs. I know they take insurance for acupuncture. Not sure about all of their services though.

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[deleted] t1_iwrsxeo wrote

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lilfoodiebooty OP t1_iws6tdt wrote

It makes me wonder what folks are doing who don’t have that kind of cash on hand week to week. I know sliding scales exist but those are limited. It just seems unbalanced and unlike anything I’ve seen before. Thank god for telehealth, my therapist is in Farmington but it sucks to take that space away from someone who was more local and needed it.

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schiddy t1_iwviqam wrote

I'm guessing those folks just go without unfortunately. Even my primary care doctor went private practice no insurance last year.

I have reduced out of network coverage and the private practices annual premium would count towards my out of pocket maximum and labs would be covered, but it's still much more expensive than in network. And I go to the Dr A LOT for existing conditions.

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lilfoodiebooty OP t1_iwvszcl wrote

Just leaves a bad taste in my mouth honestly. I’m lucky to have insurance through my employer but I opted for lower deductible insurance with no out-of-network coverage since we go so often. I wouldn’t have done that if I knew what it was like here. I’m spending weeks searching for and getting in with specialists, especially mental health professionals.

I am able to work in a demanding field because of my insurance and able to take charge of my life with a strong healthcare team. Paying $1200 each or more a month isn’t feasible, even when we make $160k as a couple. It’s made me reconsider whether we want to buy a home and settle here if we have to essentially pay out the nose for care.

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Big_P4U t1_iwsyt2t wrote

It boils down to money; Insurance tends to short change therapists by a lot, and tend to fight mental health care.

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