You Didn’t Become a Therapist to Become an Insurance Therapist

I need to tell you something that took me way too long to figure out for myself.

You probably thought you spent all those years in school to become a physical therapist, occupational therapist, speech therapist, dietitian, or whatever healthcare profession you chose. You studied anatomy, physiology, pathology, treatment techniques, and all the things you needed to learn to become great at helping people.

Then you got into the real world and realized something.

You didn't just become a therapist. Somewhere along the way, you became an insurance therapist.

And there's a BIG difference.

The Deal You Thought You Were Getting

When I graduated and started working in outpatient physical therapy in 2000, I was making $39,500 a year. Within about two and a half years, I was able to get that up to somewhere around $55,000 to $60,000.

Today, I see new grads coming out making $60,000 or $70,000, sometimes more. On the surface, that sounds better. You're making more than Greg made when he graduated 25 years ago.

Cool.

Except many of those healthcare professionals are also coming out of school with $100,000, $130,000, even $160,000 worth of student debt. Meanwhile, the cost of living has gone up, and many of them are being asked to see more patients and hit higher productivity numbers.

So yeah, the number on your offer letter might be bigger.

But does that mean you're actually doing better?

That's a very different question.

Welcome to the Free Biller Treadmill

Here's the part I think a lot of healthcare professionals don't recognize until they've been in the system for a while.

You treat the patient, but you're also responsible for documenting everything you did in a way that satisfies the payer. And many healthcare professionals end up doing at least some of that documentation outside of their paid working hours.

Think about how weird that is.

You provide the service. Then you spend additional time documenting and justifying the service so the insurance company will hopefully pay for the work that's already been done.

That's what I call the free biller treadmill.

And if reimbursement gets squeezed while operating costs and wages go up, what happens?

Productivity has to increase somewhere. More patients. Tighter schedules. More documentation squeezed into less time.

So you start running faster.

The problem is you're not necessarily getting anywhere faster.

Who Is Really Calling the Shots?

Most healthcare professionals think their employer pays them.

Technically, sure. The paycheck comes from your employer.

But where is a huge portion of the money funding the system coming from?

The payer.

And when the payer controls whether a service gets reimbursed, the payer has enormous influence over the way care gets delivered.

That's where I think we need to have an uncomfortable conversation.

You learned how to evaluate a patient. You learned how to determine what that person needs. You built your clinical judgment through years of education and experience.

Then sometimes you find yourself in a situation where you believe a patient needs something, but their insurance won't approve it.

Now what?

You might believe they need additional visits. Insurance says no.

You might believe a certain service is appropriate. Insurance won't reimburse it.

You might believe someone isn't ready to be discharged. Their benefits say otherwise.

At some point, you have to ask yourself:

Am I practicing physical therapy... or am I practicing insurance therapy?

The Payer and the Patient Aren't the Same Person

This distinction matters because whoever controls the money has influence.

In the traditional insurance model, the person receiving the care and the organization paying for that care aren't necessarily the same party.

You're helping the patient.

But you're also documenting for the payer.

You're answering to the payer's requirements.

You're waiting for the payer to reimburse the service.

And if they decide something doesn't meet their requirements, you or your employer may have to fight to get paid for work that's already been performed.

Meanwhile, you still have expenses associated with being a healthcare professional. You have your license renewal. You have continuing education requirements. Depending on your situation, you might have malpractice insurance and professional fees. And for many people, there's that giant student loan payment sitting there every single month.

That's the machine I want healthcare professionals to start seeing.

Because once you see it, it's hard to unsee it.

Your Degree Can Also Become Part of the Trap

There's another part of this that I don't think we talk about enough.

Your profession becomes part of your identity.

You didn't just get a degree. You became a PT. You became an OT. You became an SLP. You became a dietitian.

You spent years working for that title.

Your family celebrated when you graduated. You passed your boards. You got your license. You probably have letters after your name that you worked REALLY hard to earn.

So when you start questioning whether this career is working for you, it can feel like you're questioning yourself.

“I spent all this time getting this degree. What else would I do?”

“I have all this student debt. I can't leave now.”

“What happens to my identity if I'm not doing this anymore?”

And that's one of the reasons people can stay in situations that are making them miserable for years.

The degree they thought would give them freedom can become one of the reasons they're afraid to consider other options.

I Want You to Calculate What You REALLY Make

I see healthcare professionals tell me their salary all the time.

“Greg, I make $90K.”

Okay.

That's your gross salary.

That's not what I want you to calculate.

I want you to look at what actually hits your bank account after taxes and deductions. Then I want you to calculate the REAL number of hours you're working.

Not just the hours on your schedule.

Include the documentation you finish after your shift. Include the charting you take home. Include the unpaid time you're spending doing work associated with your job.

Now take your actual take-home pay and divide it by those hours.

That's the number I want you to look at.

Because saying “I make $90,000 a year” sounds great.

But what is your time actually producing for you?

Now Compare That Number With One Cash-Pay Session

Once you have your true hourly number, I want you to do one more thing.

Look up what someone in your area charges for one cash-pay session of the service you provide.

I'm not telling you to quit your job.

I'm not telling you that insurance is evil.

I'm not telling you to open a cash-pay practice tomorrow.

I just want you to see the numbers.

Compare what one person is willing to pay directly for an hour of expertise with what you're actually taking home per hour after accounting for all the time your current job requires.

Then sit with that for a minute.

Because sometimes you don't need somebody to give you another motivational speech.

You need to see the math.

You Might Not Need to Run Faster

A lot of healthcare professionals believe the solution is to work harder.

Pick up another shift.

See another patient.

Get another certification.

Stay later.

Become more productive.

But if you're already running on a treadmill, running faster doesn't necessarily get you closer to where you want to go.

That's why I wanted to talk about this.

I'm not trying to give you the entire solution today. Sometimes before we can talk about solutions, we need to become aware of the problem.

So this week, calculate your true hourly rate.

Don't use the number on your employment contract. Don't use the salary you tell people when they ask what you make.

Use the money that actually comes home and the hours you actually give away.

Then ask yourself whether the career you worked so hard to build is working as hard for you as you're working for it.

Much Love,

Greg

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