Part 1: Do You Take Insurance? Why I'm a Cash Pay PT and How Superbills Work (Kirkland PT)
This is Part 1 of a three-part series on paying for pelvic floor physical therapy. Part 2 covers what pelvic floor PT actually costs (with real math), and Part 3 is a step-by-step guide to checking your benefits and submitting a superbill.
"Do you take insurance?" is usually the first question I get, and it deserves a real answer. The short version: no, I don't bill insurance directly. Pillar Core & Pelvic Floor Physical Therapy is a cash pay practice. The longer version is worth your time, because the way a clinic gets paid quietly shapes almost everything about the care you receive. This post explains why I chose this model, what it actually means for you as a patient, and how superbills let many patients still use their insurance benefits.
What "cash pay" actually means
Cash pay (you'll also see "out-of-network" or "private pay") means you pay the clinic directly at the time of your visit, and the clinic doesn't have a contract with any insurance company. You can pay with a card, and in most cases you can use HSA or FSA funds, since physical therapy for a medical condition is a qualified expense. (A few plan administrators ask for a letter of medical necessity first; I can provide one if yours does.)
It does not mean insurance is out of the picture entirely. If your plan includes out-of-network benefits, you can submit a superbill (more on that below) and get reimbursed for a portion of what you paid. Many of my patients do exactly this.
Why I chose not to contract with insurance
When a PT clinic is in-network, the insurance company sets the reimbursement rate for each visit. Those rates have been squeezed for years, and clinics adapt the only way they can: shorter appointments, double-booked schedules, and a lot of your "PT session" spent on a bike or with a heat pack while the therapist works with someone else. None of that reflects lazy clinicians. It reflects the math they're working inside.
Insurance also gets a vote in your clinical care. Plans can cap the number of visits per year, require pre-authorization before treatment continues, and deny coverage for care they deem "not medically necessary," which often includes exactly the kind of preventative and performance-focused work that keeps a postpartum mom from developing a bigger problem later.
I built my practice around one-on-one, hour-long visits where you have my full attention from the moment you walk in. Stepping outside the insurance system is what makes that possible. Nobody else in the treatment room, no visit caps decided by someone who has never met you, and no treatment plan trimmed to fit a billing code.
What this looks like for you as a patient
A full hour, one on one. Every visit is with me, a doctor of physical therapy, for the entire session. No aides, no shared time. Because we accomplish more per visit, most patients need fewer total visits than they would in a high-volume clinic. When you compare cost per outcome instead of cost per visit, cash pay is often closer to in-network care than the sticker price suggests. Part 2 of this series walks through that math with real numbers.
Transparent pricing, in writing. You know the exact cost before you ever book. And this part surprises people: as a self-pay patient, you're legally entitled to that. Under the federal No Surprises Act, cash pay patients have the right to a Good Faith Estimate, a written estimate of expected costs for your care, before treatment begins. I provide one to every patient as standard practice. No surprise bill three months later because a claim processed differently than expected.
Care decisions made by you and me. If you're progressing and want to push toward running again, we do that. If you need more time on manual work, we take it. Your plan of care is clinical, not administrative.
No referral required to start. Washington is a direct access state, which means you can begin physical therapy without a physician referral. One note: if you plan to submit superbills, some insurance plans want a referral or diagnosis from a physician on file for reimbursement, so it's worth checking your plan's rules (see the questions below).
Superbills, explained simply
A superbill is a detailed receipt for medical care. It looks like a regular receipt, but it includes the extra information your insurance company needs to process a claim:
The diagnosis code(s) for your condition
The CPT codes describing the treatment provided at each visit
My license and NPI numbers, plus practice information
Dates of service and what you paid
You submit the superbill to your insurance company, usually through their member portal or a claims form. If your plan has out-of-network benefits, they reimburse you directly for a portion of the cost. I provide superbills to any patient who requests one, at no extra charge.
One deadline worth knowing: insurance companies set a "timely filing limit" for claims, usually somewhere between 90 days and one year after the date of service. Submitting as you go, rather than saving up a stack, keeps you safely inside that window.
Two insurance terms worth knowing
Insurance language can make anyone's eyes glaze over, so let's keep it to the two terms that actually matter here.
Out-of-network benefits. Your insurance plan has a list of providers it has contracts with. That list is the "network." A cash pay clinic like mine isn't on it, so I'm "out of network." Some plans will still help pay for care from providers outside their network, and that help is called your out-of-network benefits. Not every plan has them. Many PPO plans do, and most HMO plans don't. Your insurance card or a quick call to your plan will tell you which kind you have.
Deductible. This is the amount you have to spend on care each year before your insurance starts chipping in. Think of it as a bucket you fill each year before your plan starts paying alongside you. Here's the part people miss: every superbill you submit pours into that bucket, even before your insurance reimburses a single dollar. So submitting them is worth it from visit one.
How reimbursement usually works
Once your deductible is met, your plan pays you back a percentage of each visit, often somewhere between 50 and 80 percent depending on your plan. A quick example: say your visit costs $200, your out-of-network deductible is already met, and your plan reimburses 70 percent. You pay $200 at your appointment, submit the superbill, and your insurance later sends you $140. Your real cost for that visit was $60. Claims typically process in 30 to 90 days, so think of reimbursement as a rebate that arrives in the mail, not a discount at checkout.
Before your first visit, one phone call to the member services number on your insurance card can tell you what to expect. Ask these questions:
Do I have out-of-network benefits for outpatient physical therapy?
What is my out-of-network deductible, and how much of it have I met this year?
What percentage do you reimburse after the deductible is met?
Do I need a physician referral or prior authorization for reimbursement?
How do I submit a superbill, and what is the deadline for claims?
Write down the answers and the reference number for the call. If a claim is ever questioned, that record is gold. Part 3 of this series gives you a word-for-word script for this call and a step-by-step walkthrough of submitting your first superbill.
Common questions
Is reimbursement guaranteed? No. It depends on your plan having out-of-network benefits and on their rules for referrals and documentation. That's why the phone call above matters. What I can guarantee is complete documentation on every superbill and a clear price before you book.
What if I have Medicare? Federal rules limit how cash pay PT practices can treat Medicare beneficiaries. Unfortunately, PTs cannot charged cash for therapy services. Though non-therapy services related to health and wellness such as formulating a gym routine and unrelated to an injury can be purchased.
Can I use my HSA or FSA and still submit a superbill? Usually yes, with one caution: you can't double-dip. If insurance reimburses a visit you paid with HSA funds, that money needs to be handled correctly for tax purposes, so keep your records straight or ask your plan administrator.
Is cash pay PT right for you?
If you want unhurried, specialist-level pelvic floor care and you value knowing exactly what you'll pay, this model was built for you. If your plan has strong out-of-network benefits, you may recover a meaningful share of the cost. And if it doesn't, HSA and FSA funds can still soften the total.
If you have questions about cost, superbills, or whether pelvic floor PT is the right next step for what you're experiencing, reach out through my inquiry page. I'm happy to walk you through it before you commit to anything.
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.