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Learn why your clients would still choose to work with you as a private pay occupational therapy practice owner even if they have great insurance coverage.

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Many OTs have a strong desire to have more treatment freedom with their clients, free of the shackles of insurance companies, but are worried about being fee-for-service. There is a perception that if a client has insurance, then they would just naturally want to use that insurance rather than seeing a private pay provider.

In this video, Doug Vestal, Ph.D., share 5 reasons why many clients would actually prefer to work with an occupational therapist who is out of network and a fee-for-service provider.

This video is not intended as professional or legal advice. Be sure to seek the services of a professional and understand the risks you are undertaking.


Are you an occupational therapist feeling restricted by insurance company requirements? Are you considering opening a fee-for-service practice, but wondering why clients would choose to pay out of pocket instead of using their insurance? In this video, we will explore some surprising reasons why clients may actually prefer to see an out-of-network provider, and how this can benefit both the client and you as their therapist.

I am Doug Vestal and I’m the founder Freedom of Practice which helps OTs gain more treatment freedom, time freedom and money freedom by starting thriving private pay OT practices.  My wife and I started our own OT private pay practice in NYC in 2014 and I make these videos based on that experience to help you avoid some of the same mistakes we made.

Let’s jump right into today’s topic.  Why would your clients gladly pay out of pocket $100, $150, or even $200, when they have insurance which may only cost them a $20 or $50 co-pay.

Being Out-of-Network Allows OTs To Offer Tailor-Made Treatment Plans

First, let's talk about tailor-made treatment plans. When clients use their insurance, they often have to conform to a standardized treatment plan. But we all know that every client is unique, and there's no one-size-fits-all solution. When you operate on a fee-for-service basis, you have the freedom to design a plan that is tailored to each client's specific needs and goals. And when clients see the results of this personalized approach, they'll be more than happy to pay out of pocket.

Think about it: when was the last time you bought a suit or dress off the rack, and it fit perfectly? It's the same with occupational therapy. When you provide tailor-made treatment plans, clients get a customized fit that they wouldn't get with standardized plans.

This is a huge reason and can’t be overlooked.  And this leads to better outcomes.  After all, outcomes is what our clients want.  They don’t want “sessions” or to feel like they are doing work but no closer to making it to their goal.

It you can set yourself up with a system and environment where the focus is on doing everything you can to get them to reach their goal then you will attract clients every time.

Out-Of-Network Clients Want More Time With Their Therapists

Another reason clients choose out-of-network providers is because they get more time with their therapist. Insurance companies often limit the amount of time a client can spend with you, which can hinder progress. But when clients pay out of pocket, they can spend as much time as necessary with you.

This extra time leads to more significant progress and faster results.

It's like trying to learn a new skill or hobby. If you only spend a little bit of time each week, it will take longer to see results. But if you dedicate more time and effort, you'll see progress much faster. The same is true for your services. And when clients see that they're making progress more quickly with you, they'll be more than willing to pay out of pocket.

Private Pay OT Practices Offer More Convenience To Clients

Another benefit of operating on a fee-for-service basis is the convenience it offers clients. When clients use their insurance, they often have to deal with the bureaucracy of insurance companies.  Or, they might not even be seen at all.  Many insurance based practices have waitlists weeks long.  Clients can’t even get in and get the help they need.

This can be frustrating and time-consuming for clients.  Their problem isn’t going away – in fact, in many cases it may even be getting worse.

Imagine trying to schedule an appointment with a doctor, and having to jump through hoops to get approval from your insurance company. It's frustrating and time-consuming.

But when clients come to you, they know they can get the help they need without all the hassle.

Clients Find Fee-for-Service Providers More Flexible

Another reason clients may choose out-of-network providers is the flexibility they offer. When clients use their insurance, they may be limited in when and where they can schedule appointments. But when clients pay out of pocket, they may have more flexibility in scheduling appointments. Out-of-network providers may be able to see clients outside of regular business hours, on weekends, or on short notice.

In addition, a lot of private pay practices start by doing home visits.  If you are working with kids, with new mothers, with the elderly this is a huge benefit to your clients versus having to drive, get to the clinic early, wait in a waiting room, etc.

This flexibility can be especially valuable for clients who have unpredictable schedules or who need immediate attention.

Think about how busy people's lives are these days. They have work, family obligations, and other responsibilities. If they need occupational therapy, they want to know that they can get help when they need it, without having to wait for insurance approval or worry about scheduling conflicts. And when clients see that you can offer this flexibility, they'll be more than willing to pay out of pocket.

OT Private Pay Practices Offer High-Quality Care

Finally, clients may choose out-of-network providers because they know they'll get high-quality care. When clients use their insurance, they may feel like they're just another number on a list. But when clients pay out of pocket, they know that the occupational therapist is solely focused on their needs and goals. This level of personal attention can make a big difference in the quality of care clients receive.

Clients also know that when they pay out of pocket, the occupational therapist is not bound by the restrictions imposed by insurance companies. This means that therapists can use the most effective and innovative treatment methods, without worrying about whether insurance will cover it. Clients appreciate this freedom and the increased likelihood of success that comes with it.

It's like going to a gourmet restaurant versus a fast-food chain. At the gourmet restaurant, you know that the chef is using the best ingredients and taking their time to prepare your meal. At the fast-food chain, you're getting the same standardized meal that everyone else is getting. It's the same with occupational therapy. Clients know that when they pay out of pocket, they're getting a high-quality, personalized experience.

I think we forget that.  People will pay for quality.  People don’t want just “sessions.”  They want high quality care that they feel will move them closer to their goals.

Now, some may argue that financial considerations are the only factors that clients consider when choosing a healthcare provider. But that's simply not true. In fact, studies have shown that patients are more likely to choose a healthcare provider based on the quality of care they receive, rather than the cost.

Clients want to feel heard and respected by their healthcare providers. They want to feel like they're more than just a number on a chart. And when they receive the personalized attention and tailor-made treatment plans that come with paying out of pocket, they know that they're getting the quality care they deserve.

So there is huge opportunities for OTs in private pay practice to attract clients who have insurance, even great insurance, to paying out of pocket.

But it really resides with realizing that 1.) money isn’t the driver of a lot of decisions and 2.) your clients have a whole host of other concerns: how you help them achieve their goals faster, better, etc., than others and the quality of service you provide them being top of the list.

And if you are interested in starting your own OT private pay practice but are concerned about the cost then you’ll want to check out this video right here where I break down the most common costs and how to start for less than you imagined.