Why I Don't Take Health Insurance - And Why That's Actually Better for YOU
- Emily Waldorf
- Jun 29
- 9 min read
I made the difficult decision to stop accepting insurance because I believe you deserve better than what the current healthcare system offers.
As a physical therapist specializing in complex conditions like ACL injuries, neurological disorders, women's health issues, and hypermobility syndromes, I've watched too many patients struggle through inadequate treatment limited by insurance company rules rather than what they actually need to get better. This is one reason why I opened Hive Physical Therapy in Fayetteville, AR and why I offer programs across the globe to my online community.
Here's the truth nobody wants to tell you: insurance companies have turned physical therapy into an assembly line. They force us to see multiple patients at once, limit how many visits you can have, and make us stop treatment right when you're starting to see real progress. Meanwhile, everything we know from science tells us that getting better requires focused, frequent, one-on-one care—exactly what insurance won't pay for.
I know my prices might seem higher at first glance ($130 for your initial evaluation, $100 for each treatment session). But when you actually do the math and consider what you're getting, most of my patients end up paying less overall while getting dramatically better results. Let me show you why.
Why health insurance is failing you (and your recovery)
Let me break down what's really happening with insurance-based physical therapy, because the numbers are shocking:
Your insurance company decides when you're "done" with therapy, not your body.
Medicare triggers extra paperwork and hassles once you hit $2,410 in therapy costs, while private insurers like UnitedHealthcare now require special approval after just 6 visits. Think about that—6 visits to recover from an ACL tear or stroke? It's not based on medical need; it's based on what they want to spend.
You're probably paying full price anyway.
The average health insurance deductible hit $1,790 in 2024. This means if you need an evaluation ($200-300 at most clinics) plus 2-3 follow-up visits ($150-200 each), you're paying $500-700 out of pocket before insurance even kicks in. My total cost for the same care? $430. And you get my full attention for an hour instead of 15 minutes with three other patients.
Insurance payments to therapists keep getting cut.
Medicare dropped payments another 2.8% this year—the fourth straight year of cuts while everything else gets more expensive. This forces physical therapy clinics to pack more patients into each hour just to stay in business. Your therapist isn't choosing to rush—they literally can't afford to spend adequate time with you under insurance rules.
The paperwork is delaying your healing.
Three-quarters of healthcare providers report that insurance red tape delays necessary care by 25%. Prior authorizations can take weeks while your injury gets worse. I've seen patients lose critical healing windows because they're stuck waiting for approval for treatment that should have started immediately.
What science actually tells us about getting better
Here's what decades of research have taught us about how your body heals—and why insurance-based therapy often fails:
Your brain needs repetition to rewire itself.
Whether you're recovering from a stroke, dealing with a traumatic brain injury, or learning to move properly after surgery, your nervous system changes through practice. Lots of practice. Studies show that breakthrough therapies like Constraint-Induced Movement Therapy require 6+ hours of intensive work daily for weeks to create lasting brain changes. The watered-down versions that fit insurance schedules? They barely move the needle.
Motor learning is like learning piano—frequency matters more than total time.
Research consistently shows that practicing a movement 200-300 times per session creates lasting improvement, while the 20-30 repetitions typical in insurance-based therapy does very little. More importantly, studies prove that training 5-7 times per week produces dramatically better results than the 1-2 times weekly that insurance typically covers.
Your muscles need consistent work to grow stronger.
Multiple studies prove that working muscle groups 2-3 times per week produces significantly better strength and size gains than once weekly. Here's the kicker: research shows you start losing strength and muscle mass within 2-4 weeks of stopping training. Insurance visit limits often create exactly these gaps that undo your progress.
Pain and movement problems respond to intensive intervention.
Studies tracking thousands of patients show that starting physical therapy within 15 days of injury reduces the need for expensive surgeries by 75% and injections by 19%. But this only works when you get enough therapy—not the scattered sessions insurance provides.
Real conditions need real time—not insurance fairy tales
Let me give you some reality checks about what different conditions actually require versus what insurance typically covers:
ACL reconstruction recovery takes 40-60+ visits over 6-9 months.
You can't rush getting back to sports safely—your knee needs time to heal, your muscles need to regain strength, and your brain needs to relearn how to trust that leg. But many insurance plans cut you off at 12-20 visits, right when you should be progressing to advanced training.
Stroke and brain injury recovery requires intensive, daily therapy for months.
Research shows the most effective stroke rehabilitation involves 3+ hours of therapy daily, 5 days a week. Kids with cerebral palsy need 3-11 therapy sessions weekly to make meaningful improvements in how they move. Yet insurance often approves 2-3 visits per week maximum, and frequently less.
Complex conditions like EDS, POTS, and hypermobility need ongoing management.
These aren't conditions you "fix" in 8 weeks. POTS recovery alone requires a carefully structured 6+ month program with someone who understands these conditions. Take breaks in treatment, and patients often slide backward quickly.
Women's health recovery doesn't fit insurance timelines.
Your standard medical care gives you one 6-week postpartum checkup and calls it good. But research shows most women need 8-12 weeks of specialized pelvic floor therapy. Perimenopause brings ongoing changes that need attention when symptoms flare—not when insurance decides it's time for your next "episode" of care.
Let's talk money—the real numbers might surprise you
I know what you're thinking: "This sounds expensive." Let me show you why it's actually not:
High-deductible plans make insurance therapy expensive anyway.
If you have a $2,000 deductible (pretty typical these days) and need 8 therapy visits, you'll pay $1,800-4,800 before your insurance pays a dime. My direct-pay cost for the same treatment? $930 total ($130 evaluation + $100 for 7 treatments). Plus you get my full attention for a full hour instead of being rushed through in 15 minutes.
You'll likely need fewer total visits with me.
Studies show that patients getting focused, one-on-one care average about 4-5 visits to reach their goals, while insurance-based therapy often takes 8-12 visits for the same results. When you can work intensively without interruptions, you get better faster.
Early, quality intervention prevents expensive problems later.
Research shows that good physical therapy within the first 15 days of injury cuts surgery rates by 75% and injection rates by 19%. One prevented surgery pays for a lot of therapy sessions. One avoided chronic pain problem saves thousands in ongoing medical costs.
You avoid the hidden costs of insurance therapy.
No copays adding up over months. No surprise bills when insurance decides mid-treatment that they won't cover certain techniques. No having to start over with a new therapist when your insurance changes or your approval runs out.
Why I can offer specialized care that others can't
Not taking insurance allows me to focus on what I do best—complex conditions that need specialized expertise:
Longevity and aging athletes need more than basic exercises.
Working with people who want to stay active into their 60s, 70s, and beyond requires understanding how aging affects movement, recovery, and performance. Insurance reimbursement rates make it impossible for most therapists to spend the time needed to really understand your goals and create programs that keep you moving well for decades.
Women's health issues need specialized knowledge and time.
Whether you're dealing with postpartum recovery, perimenopause changes, or pelvic floor problems, these conditions require therapists with specialized training and the ability to spend time on thorough evaluations and sensitive discussions. Insurance systems often don't even recognize these specialties as "real" physical therapy.
Neurological conditions need creative, intensive approaches.
Helping someone recover from stroke, manage multiple sclerosis, or improve function with cerebral palsy requires thinking outside the box and using techniques that leverage how the brain heals. This takes time, creativity, and flexibility that insurance schedules don't allow.
EDS, POTS, and hypermobility disorders need therapists who "get it."
These conditions are complex, often misunderstood, and require careful exercise modification. I can spend the time needed to understand your specific challenges and create programs that help rather than hurt. Most insurance-based clinics don't have therapists trained in these areas because they can't afford to develop this specialization.
Investing in your long-term health (not just fixing today's problem)
I want you to think differently about what you're paying for when you choose direct-pay physical therapy:
You're investing in preventing future problems.
Musculoskeletal disorders cost the US healthcare system over $420 billion every year—more than heart disease or diabetes. But most of these problems could be prevented with proper early treatment and education. When I can spend real time teaching you about your body, how to move well, and how to prevent re-injury, you're investing in decades of better health.
You're getting education, not just exercises.
In our sessions, you'll learn why your problem developed, what your body needs to heal, and how to maintain your improvements long-term. This education is what prevents you from ending up back in therapy (or surgery) years later. Insurance-based therapy rarely has time for this crucial component.
You're working with someone who knows your whole story.
I'll be the only therapist working with you from start to finish. I'll understand your goals, your challenges, and your progress in a way that's impossible when you're passed between different therapists or seen with multiple other patients. This consistency leads to better outcomes and fewer total visits needed.
You can focus on healing instead of fighting insurance.
You'll never have to worry about whether your next visit is approved, whether your insurance will suddenly change coverage rules, or whether you'll have to start over with someone new mid-treatment. You can put all your energy into getting better instead of navigating bureaucracy.
The bottom line
I know that choosing to pay out-of-pocket for healthcare feels scary in our current system. But here's what I've learned after years in this field: you either pay for quality care upfront, or you pay much more later for incomplete treatment, re-injuries, and chronic problems.
The current insurance system isn't designed to get you better—it's designed to manage costs. As healthcare providers, we've been forced to choose between providing excellent care and staying in business. I chose excellent care.
My approach is simple: one-on-one treatment until you're better, whether that takes 3 visits for an acute ankle sprain or ongoing management for a complex neurological condition. No arbitrary limits, no rushing, no insurance company deciding when you're "done." Just evidence-based care tailored to what your body actually needs.
Your health is the foundation of everything else in your life. Isn't it worth investing in properly?
References
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