How We Get Paid - Why Clinicians & Clinic Owners are Getting Squeezed by Insurance Companies Artwork

Pelvic PT Rising

Helping pelvic physical therapists improve as clinicians, in their careers or business, and their lives. Hosted by Dr. Nicole Cozean and Jesse Cozean, the founders of PelvicSanity physical therapy and the Pelvic PT Huddle, the podcast explores all aspects of pelvic physical therapy. You'll find the clinical pearls that Dr. Nicole teaches in her continuing education courses, the business and career advice that catapulted PelvicSanity into one of the largest cash-based physical therapy practices in the country, and living life as business owners and pelvic health advocates. And we'll be keeping it 100% real - and having some fun - along the way!

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Pelvic PT Rising

How We Get Paid - Why Clinicians & Clinic Owners are Getting Squeezed by Insurance Companies

January 19, 2026

In this episode, we break down how money actually moves in the insurance-based PT and OT world, why so many clinicians and clinic owners feel financially stuck, and how the landscape has quietly but dramatically changed over the last 20 years.

We cover:

How insurance companies make money — and why they’re incentivized to pay out as little as possible
The reality of declining reimbursement and rising administrative costs
Why clinic owners feel squeezed from both sides
Why clinicians deserve raises — and why insurance doesn’t support that reality
How this system unintentionally pushes clinics toward lower-quality care models

Most importantly, we talk about why the rise of cash-based care isn’t a trend — it’s a correction.

Cash-based models:

Allow small, independent clinics to survive and thrive again
Create real earning upside for skilled clinicians
Restore transparency and accountability in care
Exist in every healthcare system — including countries with universal healthcare

This episode isn’t about villainizing anyone. It’s about understanding the system we’re operating in — so we can make better, more informed decisions about our careers, our clinics, and our patients.

🎧 Whether you’re an employee, a practice owner, or somewhere in between, this is required context for the modern pelvic health landscape.

About Us

Nicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health. PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016. It grew quickly into one of the largest cash-based physical therapy practices in the country.

Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes. Together, Jesse and Nicole have helped 800+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!

Get in Touch!

Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).

Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!