Why We Dumped Insurance – And Haven’t Looked Back

Why We Chose Cash-Based Physical Therapy — And Haven’t Looked Back

I still remember the first time I had to get on the phone with an insurance adjuster to dispute a denial for a patient’s treatment. I was arguing with someone who had no medical background about why my patient’s care was necessary. Frustrated, I finally asked, “Where did you get your physical therapy degree?” Of course, they hadn’t.

That moment made it clear: insurance companies aren’t in the business of helping people — they’re in the business of making money for shareholders. The patients they claim to serve are just numbers on a spreadsheet. It was the first of many frustrating encounters that revealed just how broken and controlling the insurance system is.

Most physical therapists dream of providing life-changing care. But in insurance-driven clinics, we’re forced to play by the rules of a system that doesn’t prioritize patient outcomes. With the tight grip of insurance companies around the throat of the physical therapy business, PTs are required to see more patients in less time — leaving both the therapist and the patient stuck in a cycle that rarely produces meaningful results.

The Problem with Insurance-Based Clinics (or “PT Mills”)

In a typical insurance-based clinic — what we call a “PT mill” — the priority isn’t patient care. It’s volume. These clinics have high patient loads because that’s the only way to stay profitable in an insurance-driven model. But high volume leads to low-quality care and quick therapist burnout.

Here’s what that looks like:

Patients are scheduled every 15 to 30 minutes.

PTs juggle 16 to 30 patients a day.

Therapists bounce from one patient to the next, often without enough time to give anyone their full attention.

It took me just two years working in a PT mill to realize I was completely burned out. I wanted to help people heal, but instead, I was buried in paperwork, billing codes, and endless insurance hurdles. I wasn’t making a difference in people’s lives — I was just keeping the hamster wheel turning.

Why Patients Get Stuck in the Insurance Cycle

Insurance-based clinics don’t just burn out therapists. They fail patients, too.

Here’s how it works: Insurance companies limit the number of sessions a patient can attend, regardless of their progress. They dictate what treatments are “covered,” regardless of what the patient actually needs. When those sessions run out and the patient still isn’t better, they’re sent back into the system to start all over again.

The result? Patients don’t get results. They waste time, money, and energy on a system that doesn’t prioritize their recovery.

We couldn’t accept that anymore. We knew there had to be a better way.

Breaking Free: Why We Went Cash-Based

When we realized there was an alternative to this broken system, we jumped at the opportunity.

In a cash-based model, we can focus entirely on our patients — not on what insurance companies allow. We spend a full hour with each patient. We’re no longer jumping from one patient to another, trying to squeeze care into tiny time blocks. And instead of worrying about billing codes, we focus on outcomes.

Most importantly, our care is driven by what the patient needs, not by what insurance will cover. We’ve taken control of our practice, and we’ve taken back our ability to provide real value.

The Difference It Makes

Going cash-based was a risk. But it’s one we haven’t regretted for a second.

Here’s what we’ve seen since making the switch:

Patients feel heard. We have the time to listen to their concerns, understand their goals, and build personalized treatment plans that work.

Patients get better results. Without the limitations of insurance, we can provide the treatments they actually need to heal.

We love what we do again. We’re no longer burned out. We have time to invest in each patient, and that’s why we became physical therapists in the first place.

Final Thoughts

Making the switch to cash-based physical therapy wasn’t just about improving our own work-life balance. It was about breaking free from a system that doesn’t work — for PTs or patients.

Our patients deserve better than being treated like numbers on a spreadsheet. They deserve personalized care that gets results. And now, we can give them exactly that.