Why We Don’t Take Most Commercial Insurance

“Do you take my insurance?” It’s the first question we get, and we’d rather give you a straight answer than a vague one.

The short version: we accept Blue Cross Blue Shield PPO, Medicare, Medicare Plus Blue, auto insurance, and workers’ compensation. For most other commercial plans, we’re out-of-network.

 That’s a deliberate choice, and it’s built around one thing: getting you back to full performance, not just out of pain.

Here’s why we made that call, what it means for your wallet, and how you can still use your benefits.

What Insurance we accept

If you’re covered by one of these, we bill your plan directly:

  • Blue Cross Blue Shield PPO
  • Medicare (traditional Part B)
  • Medicare Plus Blue (BCBS Medicare Advantage PPO)
  • Auto insurance
  • Workers’ compensation

You’ll still be responsible for any copay, coinsurance, or deductible your plan requires. We verify your benefits before your first visit so there are no surprises.

Not sure if your plan is a PPO or HMO? Check your card or send us a photo of the front and back. We’ll tell you exactly where you stand.

Why we're out-of-network with most commercial plans

Insurance companies decide how much care you get, how long it lasts, and what it’s worth. When those rules conflict with what it actually takes to rebuild an athlete, we choose the athlete. Here’s what in-network contracts typically require:

1. Low reimbursement forces volume. Many commercial plans pay a fraction of what a full hour of skilled care costs. To stay open, in-network clinics often see two to four patients per hour. Your “PT session” becomes 10 minutes with a therapist and 40 minutes with an aide or a sheet of exercises.

2. Visit caps cut rehab short. Plans commonly limit you to a set number of visits per year. ACL rehab, for example, runs 9 to 12 months. Insurance often stops paying once you can walk without pain, right when the real return-to-sport work should start.

3. Authorizations and paperwork slow you down. Prior authorizations, re-authorizations, and denied claims eat up time that should go to your care, and can delay your start by days or weeks.

4. Insurance defines “done” as pain-free. Most plans cover treatment until you can do daily activities. They don’t pay to get your sprint, jump, or lift back to where it was. That gap is exactly where we work.

Stepping outside those contracts lets us decide your plan based on your goals and your testing data, not on what a claims reviewer will approve.

What you get instead

Every visit at Souva PT & Performance looks the same, regardless of how you pay:

  • One-on-one time with a Doctor of Physical Therapy. No aides, no techs, no double-booking. [Confirm session length, e.g. 45 or 60 minutes.]
  • Objective testing, not guesswork. We measure strength, range of motion, asymmetry, and power with VALD DynaMo and OVR force plates, so progress is tracked in numbers.
  • Care that goes past pain-free. Your plan ends when you’re back to performing, whether that’s your sport, your lifts, or your job.
  • A plan built for you. Programming is based on your goals and your data, not a visit count approved by your insurer.
  • Fewer visits, more progress. Because each session is focused and hands-on, most people need fewer total visits than they would in a high-volume clinic.

 

In-network isn't always cheaper

“In-network” sounds like it means low cost. Often it doesn’t. Once you add up what your plan actually makes you pay, an in-network clinic can cost about the same as us, or only slightly less.

Here’s where in-network costs come from:

  • Deductible. Until you meet it, you pay the insurance company’s full contracted rate for every visit. Many plans now carry deductibles of $2,000 to $5,000 or more. For a lot of people, that means paying out of pocket for most or all of their PT.
  • Copays. Even after the deductible, many plans charge a flat fee per visit, commonly $30 to $75. Over 15 to 20 visits, that adds up fast.
  • Coinsurance. Some plans have you pay a percentage of each visit, often 20 to 30%, after the deductible is met.
  • More visits. High-volume clinics split your session between patients and aides, so progress is slower. More visits means more copays, more coinsurance, and more time off work or practice.

Example: With a $3,000 deductible you haven’t met, 15 in-network visits at a $120 contracted rate cost you $1,800. [Compare to your rate × the typical number of visits for the same injury.]

The real question isn’t “in-network or out?” It’s what you’re getting for the money you’re already spending.

 

The bottom line

Pain-free isn’t the finish line. Performance is. Our insurance model exists so your care can follow that standard, not a claims reviewer’s.

Still have questions about your coverage? Give us a call at 586-800-4364 to discuss your benefits and how we can help you get back stronger than ever. Our clinic is located inside Umbra Strength in Shelby Township. We’ll look at your injury, walk through your options, and help you figure out the most cost-effective way to get back to your sport.