What physical therapy costs in Dallas, and how insurance, superbills and HSAs fit in

The short answer on cost and coverage

The cost of physical therapy in Dallas depends less on the price of one visit than on the whole episode of care: how many sessions your problem takes, how long each session is, and how much of it your insurance actually pays after your deductible. Many in-network clinics bill your insurer and charge you a copay or coinsurance; out-of-network practices like mine charge you directly and give you a superbill so you can claim any out-of-network benefits your plan provides. Whether insurance pays, and how much, is decided by your own plan, so a five-minute call to your insurer is the most useful step you can take before starting.

I am Dr. Brent Lockett, a Doctor of Physical Therapy, and I run Osteopractic Physical Therapy & Pain Relief in North Dallas. People often ask me about cost a little apologetically, as if it were an awkward question. It is a practical one, and it deserves a clear answer about what moves the number and what you can check before you spend anything.

What actually moves the price

Two people with the same diagnosis can spend very different amounts on physical therapy. The difference usually comes from a handful of factors, and only some of them are about the clinic:

• How many visits the problem takes, which depends on the tissue involved, how long it has been going on and what you are returning to
• How long each session is and how much of it is spent with the licensed therapist
• Whether the clinic is in network or out of network with your plan
• Your deductible, and how much of it you have already met this year
• Your copay or coinsurance once the deductible is met
• Where you are seen, since visits at home or at the office take travel time
• How consistently the home program gets done, which changes how quickly visits can be spaced out

In network, out of network and the superbill

An in-network clinic has a contract with your insurer. It bills the insurer, the insurer sets an allowed amount, and you pay whatever your plan says: often the full allowed amount until your deductible is met, then a copay or a percentage. Insurers usually decide how many visits they will authorize, and reimbursement rates push many in-network clinics to see more than one patient an hour. That is economics, not a lack of skill.

An out-of-network practice has no contract with your insurer. You pay the practice directly, and the practice gives you the paperwork to file a claim yourself. My practice works this way on purpose. Removing the insurer from the arrangement means session length, what happens in each session and how many visits you need are clinical decisions rather than administrative ones. Every session with me is a full 60 minutes, one-on-one, which I explain in more detail in what a one-on-one hour changes.

A superbill is an itemized receipt that lists the diagnosis and procedure codes an insurer needs to process a claim. At the end of every session with me, you receive one. You can submit it to your insurance company for any out-of-network reimbursement your plan includes.

A superbill does not guarantee that anything comes back. That decision belongs to your plan, and plans vary widely: some reimburse a percentage of out-of-network physical therapy once a separate out-of-network deductible is met, and some do not cover out-of-network care at all. It is still worth keeping every superbill, because a claim is much easier to assemble as you go than at the end of the year.

Deductibles, HSAs and FSAs

Many people compare one out-of-network session with one copay, but if your deductible has not been met, the in-network visits are paid out of pocket anyway until it is. For someone with a high-deductible plan, the real comparison is often between two out-of-pocket amounts, not between a session price and a small copay.

Health savings accounts and flexible spending accounts change the effective cost for many people. IRS Publication 502, which defines medical expenses for tax purposes, states that you can include amounts you pay for therapy received as medical treatment. Your account administrator has the final word on what your specific account will pay for, so ask them before you rely on it. If you are reviewing your coverage this fall anyway, this guide to the annual health insurance checkup walks through what to look at before open enrollment closes.

The three questions to ask your insurer before you start

Call the number on the back of your insurance card and ask these questions. Write the answers down, along with the date and the name of the person you spoke with. Five minutes on the phone turns the whole question from a guess into arithmetic.

• Do I have out-of-network benefits for outpatient physical therapy?
• What is my out-of-network deductible, and how much of it is already met this year?
• Once it is met, what percentage of the allowed amount is reimbursed, and is there a visit limit?
• Does my plan require a physician referral or prior authorization for reimbursement?

Medicare is its own conversation

Medicare works differently from commercial insurance. According to Medicare.gov, Part B helps pay for medically necessary outpatient physical therapy, and after the Part B deductible you pay 20 percent of the Medicare-approved amount. Medicare.gov also states that your doctor or another health care provider, such as a nurse practitioner or physician assistant, must certify that you need the therapy.

If you have Medicare, mention it when you first contact any practice, including mine, so the position is clear before anything starts. Getting that right at the beginning avoids a great deal of difficulty later. Texas referral rules are a separate question from insurance rules, and I cover both in seeing a physical therapist in Texas without a referral.

Why fewer, fuller visits can cost less overall

The number of visits matters more than the price of any single one. When the hands-on treatment, the loading and the coaching happen in the same hour with the same clinician, progress tends to come in fewer sessions than when those pieces are split across shorter, partly supervised visits. Add the time off work and the drive for every extra visit, and the comparison often narrows.

Starting sooner also tends to cost less. A study of private insurance claims published in Health Services Research in 2012 compared physical therapy episodes that began with a physician referral with episodes where patients went to the physical therapist directly. The self-referred episodes had fewer physical therapy visits, 86 percent of the physician-referred number, and lower allowed amounts, with no difference in related health care use afterward. For a closer look at what decides visit numbers, read how many physical therapy sessions it takes.

Costs that never appear on the bill

When people add up what physical therapy costs, they usually count only the invoices. The bigger costs of a problem that drags on are often the ones nobody sends a bill for, and they belong in the comparison too:

• Time away from work for each visit, including the drive and the parking
• The extra visits a plan needs when sessions are short and progress is slow
• The next episode, when care stopped as soon as the pain did and the back or knee was never rebuilt
• Imaging, injections or specialist visits that sometimes follow a problem left alone for months
• Training, golf or time with your family that you give up while you wait
• Pain medication taken most days just to get through the week

When out-of-network care is probably not the better deal

I would rather tell you this at the start than have you find it out later. If you have strong in-network benefits, a low copay, a deductible you have already met and a straightforward problem, in-network care may make more financial sense. The same is true when you will need very frequent visits for many months, such as after a major joint replacement, where coverage makes a large difference.

And if cost would stop you from finishing the plan, that matters most of all. A plan you abandon halfway is worse value than a cheaper one you complete. If that is your situation, I will say so at the discovery visit.

How pricing works with me

So that you can compare like with like, here is what one session in my practice contains. The full hour is with me, never handed to an aide or shared with another patient. Assessment continues throughout the session, so the plan adjusts in the room rather than at the next visit. Hands-on treatment, such as manipulation, dry needling, cupping or instrument-assisted soft tissue work, is used where the examination supports it, and it is followed in the same hour by loaded movement and coaching. You leave with exercises and self-mobilization techniques to use at home, and with a superbill.

Every session is 60 minutes, one-on-one with me, at my clinic on North Central Expressway or at your home, office or gym. Visits at home carry an added charge because they include travel time, and most clients find the clinic works best for their plan. I offer single sessions and multi-visit packages, and a shorter 30-minute dry needling session for focused relief. Call the practice for current pricing; you will get it plainly, before anything starts.

The first step is a free discovery visit, a short, no-obligation conversation in the clinic or by video. You can ask what a plan for your problem would likely involve and what it would cost before you commit to anything. You will receive a superbill after every paid session, and no physician's prescription is needed to begin.

Questions people ask me