PT Rebels Podcast Episode
Host: Dr. Gina Fick
Guest: Taylor Todd, PA-C, Dermatology Specialist
Episode Introduction
Taylor Todd: I think that a lot of patients think that insurance is on your side. I think that people have this misconception that your insurance company is your friend, and that if they’re behind you, you are covered and you’re gonna get the best care you need—and that is not true.
I think back 20, 30 years ago, that may have been true, and I think that insurance companies partnered with physicians in a way where it actually did make sense to go through your insurance and you were getting better deals. Now it’s set up a little differently, in my opinion. I’m using this conversation right now to educate people with insurance too, because people don’t understand.
Dr. Fick: Welcome to the PT Rebels podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.
Guest Introduction
Welcome back to the podcast everyone. On today’s episode, we have a special guest, Taylor Todd. Taylor is a board-certified physician assistant specializing in dermatology.
Taylor completed her undergraduate degree at California State University San Bernardino and graduated Summa Cum Laude with a degree in public health. She went on to complete her master’s degree in physician assistant studies at Loma Linda University, where she received high honors from the School of Allied Health Professions.
Taylor has focused her career on medical dermatology and has practiced in different locations, including Southern California and Arizona, before eventually relocating here to Colorado. She is currently a member of the American Academy of Physician Assistants, the Colorado Society of Dermatology Physician Assistants, and is a fellow of the Society of Dermatology Physician Assistants. She’s board certified through the NCCPA.
Taylor continues to diagnose and treat a wide variety of skin conditions and enjoys helping her patients find successful individualized treatment plans for their unique skin conditions. She believes in high-quality, compassionate healthcare where patients feel included in the decision-making process. Taylor strives to build lasting relationships with all of her patients.
In her free time, Taylor enjoys long distance running, hiking, camping, and spending time with friends and family.
Interview
Background and Introduction to Fick PT
Dr. Fick: Many of you might wonder why we’re having a dermatologist on the podcast. The reason is, number one, Taylor is a patient here at Fick Physical Therapy and Sports Performance and has kindly agreed to come onto the podcast. But she also has a lot of unique insights into healthcare in 2024 and what that looks like, not only for our clients, but her clients as well. Taylor, can you tell us a little bit more about yourself?
Taylor: I originally moved here from Arizona about two years ago, and I have been working at Clarity Dermatology as a physician assistant in dermatology for two years. I ended up having some of my own physical problems and then found my way over here.
Dr. Fick: How did you find Fick PT?
Taylor: I was having some of my own spine issues and I actually went up to Castle Rock Spine Clinic to see a physician up there. While I was there, they felt that physical therapy would be a good addition to the treatment that I was having, so they led me here.
Previous Physical Therapy Experiences
Dr. Fick: Can you tell our audience a little bit more about why you chose Fick PT?
Taylor: Interestingly enough, I think there are a lot of people out there who’ve probably been in my shoes. I had been to physical therapy in the past—I was a cross country runner in high school and ran a lot throughout college. Obviously we run into moments where we have injuries.
I had always been sent to clinics where I was using health insurance, and I was not impressed with the care that I had received. That’s not to belittle any clinic in particular, but I just felt so rushed. I basically was getting these 30-minute appointments and I didn’t feel like anything really got accomplished. I thought, “Wow, I don’t want to do physical therapy again. I felt like it was a waste of my time.”
I think a lot of patients feel that way—they think it doesn’t do anything. When I went to see my physician in Castle Rock for some treatments for my back, they mentioned finding another physical therapist. I read up on your clinic and thought, “Oh, maybe this is a little different.”
I also noticed one of the differences was that it was cash pay. At first, I think that’s a little scary for people, but I realized maybe this is gonna lead to something that I didn’t have before. So I thought I’d give it a chance.
Cash Pay vs. Insurance-Based Care
Dr. Fick: In terms of out-of-network or cash pay versus insurance, can you tell us how that’s been different for you? What does the initial experience look like from evaluation to treatment?
Taylor: It’s really interesting. I’m being cautious because I don’t want to belittle other offices or clinics that take insurance—I’m sure there are great ones out there. But I do notice that even with the evaluation, there was so little time to really gather information at some of the other physical therapy offices I’d been to, even in high school. I didn’t know there could be a difference—I just figured every physical therapy office worked like that.
Even from the initial evaluation, I felt like I was given adequate time for somebody to evaluate my problem and then make a really good, educated decision about what the treatments needed to be moving forward. That was something I hadn’t received before, and I noticed a difference right away.
A lot of clinics that take insurance find it necessary to have physical therapy aides because they don’t have a lot of time to spend with the patient on their own. It’s limited—you have 30 minutes with the physical therapist, they do some of your exercises, teach you what you need to do for the next week, and then they hand you off to their physical therapy aide. You’re doing your exercises for maybe another 30 minutes, and then you’re out.
It feels very canned. Everyone’s given the same treatment, same evaluation, same everything, and there’s nothing that’s really tailored to the individual patient. What I’ve noticed with this cash pay model is that physical therapists are given a lot more freedom to do what they want to do. They’re given the ability to tailor your treatment to how they need it to be, and there’s no limited time pressure.
Navigating Complex Healthcare Decisions
Dr. Fick: Can you go into the perspective of what you go through when you’re trying to figure out what’s wrong with you? The number of physicians sometimes that you have to go ahead and go through to even get an answer, and then maybe physical therapists like ourselves who are able to draw that in and say, “All right, here’s what’s going on. Here’s how we can help you.”
Taylor: The healthcare system is really complicated and very complex. What I’ve learned—and I took it for granted because I am a medical provider and really know how to navigate things—is that you have to be your own self-advocate. A lot of patients don’t know how to do this.
It’s very confusing to navigate: “What do I need? Who do I see?” Oftentimes patients feel limited because they think they have to use their insurance. I had to go to a few different people before I figured out what to do. I had to meet with a few different spine surgeons, and oftentimes I was met with the answer that I needed surgery—that they needed to just jump in, cut me open, and replace things or fuse things. Some said, “Oh, you don’t need surgery, just wait it out.”
That was very confusing because I’d never been a patient in that situation before where it was something unfamiliar to me and I didn’t know what to do.
Dr. Fick: You were going to some of the best spine surgeons in the country or in the world. You did your due diligence and looked into this. I think that’s what’s important for people to understand—even when you picked the very best, it may be that surgeon sees something that they can operate on. However, that may not be what you need.
You have to be your own advocate and really work through these things. You need someone along with you to say, “All right, let’s sit down and let’s think about this logically.” For you, you have medical knowledge and training, but I think it’s even more confusing for a lot of our patients who go see a knee surgeon, the surgeon says yes, you need knee surgery, and they do it. Sometimes they’re not better afterwards.
The Insurance Reality
Dr. Fick: Speaking from your perspective as a dermatology PA, what’s your experience with insurance companies?
Taylor: Unfortunately, healthcare is a business in America, and it’s very frustrating that we tie our money to somebody’s health. Instead of making the decisions that are best for the patient, we’re making decisions based off of what the insurance is gonna cover. If they’re not gonna cover this, we’re not gonna do it.
I think patients also don’t even realize that they can pay cash. It’s a very confusing healthcare model. Some patients, if they don’t have insurance, think they can’t even pay cash. A lot of times, certain offices will tell patients, “No, you have to use your insurance.”
Now, that’s true if you’re Medicare or Medicaid—if you’re government insurance—but if you have commercial insurance, you’re more than welcome to pay cash. And oftentimes that can even be cheaper.
Insurance Company Challenges
Taylor: I think that a lot of patients think that insurance is on your side. People have this misconception that your insurance company is your friend, and that if they’re behind you, you are covered and you’re gonna get the best care you need—and that is not true.
I’ve had a number of patients who have certain conditions. One patient in particular has a very rare skin condition where there are probably only 800 people in the United States that have it. When we talk about case studies, there really are not that many out there, or double-blind studies talking about the proper medication to use. So we have to use certain case studies that have been performed to come up with the treatment plan.
The insurance company just will not cover the medications that this patient needs because it’s not FDA approved. How do you get that FDA approved if you can’t do these trials and studies, and we don’t have enough patients to do that?
Trying to go to bat for these patients—this is just one example. I have plenty where I’ve had to write letters, send them case studies showing them that a patient actually needed this care. It’s important for patients to understand that we, as medical providers, deal a lot with insurance, and they’re not always out to help you. They’re out to help you get the medication that is going to be the least expensive for them.
A Specific Insurance Battle
Taylor: I just got something approved for my patient who has psoriasis. He wanted to take Otezla, which is an oral medication to help with his psoriasis. He was actually a pilot, so he legally could not take another biologic—he had to be on Otezla.
His insurance company fought with me for five months to get this covered for him because I had to keep sending appeals saying, “What do you not understand? He cannot take this medication. Do you want to tell him why he’s going to lose his job? Because I’m not going to tell him that.”
This is a common finding. A lot of patients don’t realize what we go through behind the scenes so that patients can get what they need, because your insurance company is not fighting for you. They’re not for you.
The Cash Pay Advantage
Dr. Fick: What are some of the most beneficial treatments that you’ve had here at Fick PT that maybe you couldn’t get elsewhere?
Taylor: Being in a situation where I was using the cash pay model, you guys had far more time to spend with me. I think what was beneficial about my particular situation is that my problem really wasn’t just something that could have been helped with just exercises.
I think I had other problems where dry needling, laser therapy, manual therapy—how many times you’ve had to help me with some of the trigger points that I’ve had to try to work out some of these really tight, angry muscles. I understand there are some clinics that do offer that, but with my own experience, I would not have gotten that extra additional therapy if I’d gone somewhere else.
The fact that we had time to do that care—whereas if I had gone somewhere else, I would’ve been given 30 minutes and out the door and I probably would’ve come back 15 times before I saw any improvement. Within the first two weeks, I was shocked. I was like, “Wow, I wish I would’ve asked you about this sooner.”
Research Supporting Cash Pay
Dr. Fick: There’s actually been studies comparing private pay versus insurance-based physical therapy. There was a study published in 2019 looking at the overall spend of patients. In this study, private pay patients spent an average of 5 visits with that physical therapist, and they spent an average of 7.3 visits in the insurance-based practice.
They actually spent an average of $936 in the insurance-based practice and an average of $600 in the private pay practice. In the private pay practice, 100% of that time was spent with the physical therapist versus in the insurance-based physical therapy clinic, 50 to 70% of that time was spent with a physical therapist.
What that study tells me, and what we’ve also seen practically here in the clinic, is we see patients for fewer visits, and they actually spend less money with us than they would in insurance-based care because they’re getting the time that they need. They’re being heard, they’re being listened to. The physical therapist can gain a better understanding of what’s actually wrong and treat the right thing, and they get better faster, and they spend less money.
The Insurance Business Reality
Dr. Fick: Insurance is a very big business and lucrative business. Let me talk about UnitedHealthcare for a second because they literally torture physical therapists. If you’re a physical therapist listening, you will understand—UnitedHealthcare literally tortures physical therapists in that they require you to do such extensive recertifications every few visits.
They give you two, three visits per diagnosis, and then they say, “Oh no, they don’t need any more visits,” and you literally have to go through writing up this evaluation again. The patients have to fill out outcome surveys. You might get one more visit, two more visits. I’m on the phone with their authorization specialist who’s telling you what your patient needs.
This is a healthcare insurance company that last year had revenue of $371.6 billion. You can look it up—it’s online. They benefit from denying your services.
In Colorado, for example, with physical therapy, the average reimbursement is around $65 per visit. Physical therapists cannot keep a practice open if they see one to two patients an hour at that rate. There’s no way I can run a practice like that. So I have to see at least four or five patients an hour just to be able to pay the bills.
Taylor’s Patient Load
Dr. Fick: Taylor, how many patients do you see in a day on average?
Taylor: Probably 27 to 32.
Dr. Fick: So 27 to 32 patients a day. How much time on average do you have with your patients?
Taylor: I try to make it around 15 minutes per each person. I try to give everybody the time they need, but 15 minutes is a lot in today’s world. I know some physicians who’ve told me they have two to three minutes per patient.
Why They Continue in Healthcare
Dr. Fick: What is your why? Why do you still go to work every day and try to help these clients?
Taylor: My why is I really get joy out of helping people. I love knowing that I’ve made a difference in someone’s life, and hearing from patients that their skin condition has been so difficult to treat and they come back to me and say, “Thank you so much for working with me and sticking with me and helping me through this hard time.”
I really care about the patients. My why is even when I have frustrating days with insurance companies or dealing with things I have to deal with behind the scenes, I still get huge gratification out of knowing that I’ve made a difference in someone’s life.
Dr. Fick: I get a lot of job satisfaction out of people coming in here and me being able to help them get back to running or get back to the sports and activities they love, as quickly and safely as possible, to get fast answers, to get thorough care. That’s really what drives us as well.
Advice for Healthcare Providers
Dr. Fick: If you had to give any advice to other healthcare providers out there who are considering a cash pay model, what would you tell them?
Taylor: I know it’s scary. Definitely you have to do your homework and you have to do your research. I would definitely consider it. It’s stressful to think about starting something like that, but once you get going and you see the difference it makes in how you can treat patients and the outcomes, I think it’s worth it.
I know there are actual medical providers who have considered it. I know a few primary care physicians who’ve gone that route—a couple from UC Health that I know who’ve left their regular insurance-based model because they were tired of these big companies telling them what to do and how fast to see patients.
I think there’s this revolution where people are starting to realize they don’t have to live that way as providers. You don’t have to go and see 50 patients a day and never have a life and not see your children—there are other ways.
Dr. Fick: I was scared to death when I started all of this and everyone told me it wouldn’t work. I actually had someone say, “I’m sorry, you think this will work for you.” I said, “You know what? I’ve been doing this long enough and feel like I’m pretty good at what I do. I can come back to this, but I think this can work.”
People will pay for what they value. If you think about it, how much are women in Highlands Ranch paying to go get their nails done? To get their hair blown out, to get massages, plastic surgery, or even regenerative medicine procedures? People are spending $25,000 to go have their stem cells banked in the Caymans because people need help.
People want answers, and people will spend money on what they really value and need. That’s why I think this model can work. It doesn’t work for everyone—it doesn’t work for all clients—but I think what we’re seeing is a trend and people starting to realize that they have some choices in the way that they want to carry on their lives.
Final Thoughts
Taylor: I really enjoyed our talk today. Hopefully this has helped to open some people’s eyes and help people understand there is an option for cash pay. I think a lot of people don’t understand insurance—they think it’s on your side, they’re for you. “Why in the world would someone even dare ask for cash? Why don’t they take your insurance?” There’s so much confusion and misconception.
I thought I was smart. I worked in this industry. I thought I understood it. It wasn’t until I really started diving in as a patient that there were things I didn’t fully understand. That’s why I’m passionate about coming on here and talking about it—because I think patients deserve to know that there are more options out there.
When insurance models are not working, patients deserve to know that they have a way out and that there are other ways to go about it. Oftentimes, what’s offered to you by your insurance and what’s covered by your insurance is not what is best for you.
Contact Information
If you have any questions about how this model of care can benefit you, please reach out to us. We’re happy to have a conversation with you and help you understand better how this can work for you.
Website: www.fickptandperformance.com
Phone/Text: 480-286-6636
We’d love to speak with you, talk with you, answer your questions, and get you the help and care that you need.
Dr. Fick: Taylor, thank you so much again for your time. We really appreciate you.
Taylor: Thank you for having me. It’s been fun. It’s been interesting navigating this topic that is really hard to understand.