Part 2: Is Cash-Pay Pelvic Floor PT Worth It? The Real Cost After Insurance Reimbursement (Kirkland PT)
This is Part 2 of a three-part series on paying for pelvic floor physical therapy. Part 1 covered why I'm a cash pay practice and how superbills work. Part 3 is a step-by-step guide to checking your benefits and submitting your first superbill.
"How much is this actually going to cost me?" is the question underneath "do you take insurance," and it deserves its own answer with real numbers, not just the concept of reimbursement. This post walks through what a course of care at Pillar Core costs at sticker price, what it can look like after your insurance reimburses you, and how that compares to what you'd pay for in-network PT once you account for copays, deductibles, and visit limits.
What a course of care costs, sticker price
Here's my current pricing:
Initial evaluation: $250 (90 minutes, in-person) or $200 (60 minutes, virtual)
Follow-up visits: $200 (60 minutes, in-person)
A typical course of pelvic floor PT runs somewhere in the range of 6 to 12 visits over 3 to 6 months, though this varies a lot depending on what you're working on and how you respond to treatment. Using a mid-range example of one evaluation plus 8 follow-ups, the sticker price looks like this:
$250 (eval) + 8 × $200 (follow-ups) = $1,850
That's the number before any reimbursement. It's also the number most people stop at when they're comparing cash pay to insurance, which is understandable, but it's only half the picture.
The same math, with reimbursement
Say your plan has out-of-network benefits, your deductible is already met, and your insurer reimburses 70 percent, similar to the example from Part 1. Applied to the $1,850 course of care above:
$1,850 × 70% = $1,295 reimbursed
Your real cost: $555 for the full course of care, roughly $62 per visit once reimbursement comes back.
If your plan reimburses closer to 50 percent, your real cost lands around $925, about $103 per visit. If you haven't met your deductible yet, your first several superbills go toward meeting it rather than coming back as cash, which is worth planning for financially even though it still counts toward your annual out-of-pocket costs.
Note: insurance reimbursement percentages are calculated based on your plan's "allowed amount" for out-of-network physical therapy, which is your insurer's own determination of a reasonable fee, not necessarily the full amount you were billed. If their allowed amount is lower than what you paid, your actual reimbursement will land a bit below the simple percentage math above.
The reimbursement percentage is the single biggest variable here, which is exactly why the phone call to your insurer in Part 1 matters before you commit to a plan of care.
What in-network PT actually costs
Cash pay only looks expensive next to a flat $30 co-pay. But that co-pay is rarely the whole story. A few things that change the comparison:
Deductibles apply to in-network care too. If you have a high-deductible health plan, which is now common, you're often paying the full insurance-negotiated rate out of pocket until you hit your deductible, sometimes $1,700 to $8,500 or more before your plan contributes anything. That negotiated rate can be close to, or even higher than, a cash pay session.
Visit caps are real. Many plans cap physical therapy at 20 to 30 visits per year, combined across every type of PT you use. Once you hit the cap, you're paying full price anyway, and often mid-way through a plan of care you'd rather not interrupt.
Session length matters less here than you'd expect. Pelvic floor PT is often an exception to the high-volume model, and plenty of in-network pelvic floor therapists do offer 45 to 60 minute one-on-one visits. What differs more reliably is who gets a say in how long your care continues. With insurance involved, visit caps, pre-authorization, and documentation requirements shape the plan alongside your clinical needs.
None of this means insurance-based PT is a bad choice. For plenty of people, especially with a low deductible already met, it's the more affordable option and a perfectly reasonable one. The point is that "cash pay costs more" isn't automatically true once you run the actual numbers for your specific plan.
Cost per outcome, not just cost per visit
The per-visit price is the easiest number to compare, and the least useful one on its own. What actually determines your total cost is how many visits you end up needing, and whether anyone can cut your care short before you're done.
Because I'm not working against insurance-set visit rates, I can give each patient more time, and that time compounds. More of the session goes to hands-on work and to building a plan around your specific presentation, which means patients often need fewer total visits overall. Fewer visits means the total course of care can land closer to in-network care than the per-session sticker price suggests, before reimbursement is even factored in.
It's worth asking any clinic, cash pay or in-network: how many visits does a typical case like mine take, how often would I come in, and what happens in each session?
A quick way to estimate your own numbers
Multiply your expected number of visits by $200, plus $250 for the evaluation, for a rough sticker-price total.
Call your insurer and ask what percentage they reimburse for out-of-network outpatient PT once your deductible is met (see the five questions in Part 1).
Multiply your sticker-price total by that percentage to estimate your reimbursement.
Subtract that from your sticker-price total. That's your real, out-of-pocket number.
If you have an HSA or FSA, that same total can typically be paid using those funds, which softens the upfront cost regardless of what your insurance reimburses later.
Common questions
Does the evaluation get reimbursed at the same rate as follow-ups? Usually yes, insurers typically apply the same out-of-network percentage to all covered CPT codes, but it's worth confirming since evaluation and treatment codes are billed separately on your superbill.
What if I don't know how many visits I'll need? That's normal at the start. After your evaluation, I'll give you an honest estimate based on what we find, and we'll revisit it as you progress rather than locking you into a fixed package.
Is reimbursement guaranteed? No. The numbers in this post are examples, not quotes. What you actually get back depends on whether your plan has out-of-network benefits, where you are against your deductible, and your plan's allowed amount for physical therapy. What I can promise is a complete superbill for every visit and a clear price before you book.
What if I have Medicare? Federal rules prevent me from providing physical therapy treatment to Medicare beneficiaries, even if you'd prefer to pay out of pocket. I can offer wellness services such as fitness and general conditioning work that falls outside the scope of PT treatment. Reach out and I'm happy to talk through what that looks like.
Next in this series
Part 3 walks through, step by step, exactly how to call your insurer, what to ask, and how to submit your first superbill so none of this stays theoretical.
If you'd rather talk through your specific numbers before booking, reach out through my inquiry page, and I'm happy to help you estimate what your care would actually cost.
Dr. Sarah Eichenbaum, DPT, is the owner of Pillar Core & Pelvic Floor Physical Therapy in Kirkland, WA, providing one-on-one pelvic floor and core physical therapy for women across the Eastside.