The 7 Differences Between Private Pay vs. Insurance PT. Here’s the Honest Truth. ⬇️
🤨One of the most common questions we get at our clinic is “Why would I pay out of pocket when I have insurance?”
It’s a great question. And the truth is, both private pay care (also called out-of-network care) and in-network care have their place. But when it comes to pelvic floor therapy, the two models of care can look very different.
Let’s unpack the 7 differences, so that you can make the choice that’s right for you.
Difference #1: Treatment Approach
Insurance Clinics: Often guided by insurance rules, these clinics are restricted in their treatment strategies due to insurance placing limitations on care ⛔️. Limitations include denying treatments that are best for you, not covering treatments for higher level goals like running and exercising leak-free and pain-free, and less time with your Doctor of Physical Therapy. Due to these limitations, there is a heavier emphasis on cookie-cutter plans and what’s billable vs. what’s actually best for you to get the best results.
Private Pay: Your treatment plan is customized to you; not what your insurance approves. We treat the root cause of your problem using a whole-body approach ✅, which insurance companies do not allow for at in-network clinics. A whole-body approach means long-term results. We focus entirely on your needs, goals, and preferences without restrictions. Your treatments are based on evidence-based care, experienced Doctors of Physical Therapy, and your individual preferences.
Difference #2: Consistency of Individualized 1:1 Care
Insurance Clinics: You may rotate between therapists, see a PT aide, or share time with other patients. This makes it very challenging to see progress and stay on track when you have to re-tell your story each time you have a session 🥴. Some therapists may give conflicting recommendations and treatments, which slows down results and prolongs the duration of care leading to scheduling even more appointments, more often in order to see any changes.
Private Pay: You get undivided attention from the same, highly specialized Doctor of Physical Therapy at every session 👩🏻⚕️. No switching providers between visits, no PT aides, no distractions, and no cookie-cutter plans. You are always with your hand-selected Doctor of Physical Therapy who knows your medical history and understands your goals and the steps to achieve your goals. This consistency and continuity of treatment means faster results in fewer visits for you.
Difference #3: Highly Specialized Doctors of Physical Therapy
Insurance Clinics: Depending on where your insurance sends you, you may be seen by a generalist. While many providers are knowledgeable and well-meaning, not all have advanced training or extensive experience in pelvic health. With pelvic floor therapy becoming more common and a “buzzword” 🐝, it’s important to know that not every clinic that offers it actually specializes in the nuances of bladder, bowel, or sexual health dysfunction, complex pelvic or back pain, or prenatal and postpartum care.
Private Pay: You are working with a specialist who has advanced training in your exact issue (hello, pelvic floor muscles!). Our Doctors of Physical Therapy have spent years practicing 🩺 in this specialty and have completed hundreds of hours of advanced training 📚. We highly encourage you to ask LOTS of questions when selecting the clinic you want to receive treatment at to ensure your Doctor of Physical Therapy has advanced training in internal and external pelvic floor muscle assessment and treatment.
Difference #4: Appointment Availability
Insurance Clinics: One of the most common complaints we hear about in-network clinics? “I can’t get in.” Insurance-based clinics often run on a high-volume model (this means they see hundreds of patients a week 😵💫). If you’re looking for pelvic floor care specifically, you may also face long waitlists just to get started, and follow-up availability can be just as limited. That means bouncing between providers or delaying care based on what’s available… not what you actually need.
Private Pay: At private pay clinics like ours, we build our schedule around you to ensure you have an elevated experience and that your Doctor of Physical Therapy is focused on only you during your entire treatment session, not focused on your insurance company’s constraints or productivity or billable quotas. With smaller caseloads and fewer patients per day, we can often get you in quickly and work around your schedule. That means less waiting, more consistency, and faster progress 💯. Plus, our appointment slots are reserved specifically for pelvic health, so you’re not competing with post-op knees or sports injuries for a spot. Just quality care, right when you need it.
Difference #5: Pricing
Insurance Clinics: Insurance clinics can seem like the more affordable option at first, especially if you’re banking on just paying a small co-pay. But here’s the catch 🐟: if you haven’t met your deductible or if the clinic bills multiple codes per visit, you may end up with surprise bills that are higher than expected. Some people even find they’re paying just as much (or more) than they would at a private clinic… without the same level of personalized care. And let’s be honest… your insurance isn’t always crystal clear. Charges can show up weeks or months later for services that weren’t covered, weren’t authorized, or were billed differently than you thought. That makes it hard to budget for care and can feel frustrating.
Private Pay: Private pay clinics like ours provide upfront and transparent pricing 👍🏼. You know exactly what a session costs before you ever walk through the door. No surprise bills ever, no hidden fees, no decoding Explanation of Benefits letters. Yes, it’s an investment in yourself for one-on-one, uninterrupted time with a specialist focused solely on your body, your goals, and your results. Because our care is targeted and sessions are longer, most patients need fewer visits overall, which means better results in less time (and fewer co-pays or surprise bills piling up).
Difference #6: Number of Sessions
Insurance Clinics: With insurance-based care, your treatment plan is not based on your progress, but on your policy 📄. That means the number of visits is determined by your insurance company, not your provider. So even if your body needs more time, your insurance says you’re “done” before you’re actually feeling better. Insurances only approve visits for things they deem “medically necessary,” which doesn’t always include real-life concerns like leaking with workouts, pain with sex, core weakness, or prep for delivery and postpartum recovery. And since appointments at insurance clinics are often shorter and less personalized, you might find yourself needing more visits just to make the same amount of progress. That’s more time driving, scheduling, and co-paying without guaranteed results.
Private Pay: At a private pay clinic, your body and your goals lead the plan, and your Doctor of Physical Therapy prescribes the number of visits necessary to reach your goals 🏃🏽♀️ based on your exam findings 🔎. No session caps. No fighting for authorizations. No jumping through hoops to justify why your pain or symptoms matter. We work with you to adjust frequency based on your progress and your needs. That might mean weekly sessions at first, tapering to biweekly or monthly as you improve or popping in as needed for tune-ups, recovery, or maintenance. Our goal? To get you better, faster with fewer visits and way more impact.
Difference #7: Who Calls the Shots
Insurance Clinics: In the insurance world, the decisions often come from outside the clinic. Your care plan, number of visits, what treatments are allowed, and even if your issue qualifies for coverage or not… all of that is dictated by the insurance company, not your provider. It can feel like your recovery is being managed by a rulebook 📕 instead of real results and real evidence-based care. That might mean cutting care short, skipping valuable treatments because they aren’t “covered,” or getting stuck in a back-and-forth of authorizations and denials.
Private Pay: When you’re paying privately, you and your therapist are in the driver’s seat 🚙. No middlemen, no red tape, and no arbitrary rules about what your body needs. Your care is customized based on your goals, your progress, and your preferences (not based on insurance rules). You’re in control of your healing journey, and that’s exactly how it should be.
So, Why Pay Out of Pocket?
It’s not about “better or worse.” It’s about what works best for you. ⚖️
Private pay care is about access to a different model of care… one that prioritizes your time, your results, and a true patient-provider connection. If you’ve tried in-network care and felt like something was missing… This might be the missing piece.
And for many of our patients, that one-on-one time, the deeper support, and the personalized approach are exactly what they’ve been looking for.
Want to see if it’s a good fit for you?
Let’s chat. Book a chat and get your questions answered, no strings attached.
