[#7] Is Your Insurance Actually Costing You More? The Sunk Cost Trap

Most athletic adults assume using their insurance for physical therapy is the smart financial move. But what if staying with a physical therapist who isn't helping you is actually costing you more?

In this episode, I share a personal experience with dental insurance that reveals a trap many people fall into without realizing it: the sunk cost fallacy. It may seem like a no-brainer to use insurance that you’re paying monthly premiums for. But many people never factor in time, copays, and delayed recovery into the overall cost equation.

I break down how this pattern plays out in physical therapy, how business limitations can affect your care, and how to honestly evaluate whether the care you're getting is moving the needle. You'll learn what questions to ask, what signs to watch for, and why getting a second opinion can sometimes be in your best interest.

Main topics covered:

• The dental story that sparked this conversation
• What the sunk cost fallacy is and how it shows up in healthcare
• The real math behind "free" insurance visits
• Signs your current physical therapist might not be the right fit
• How to evaluate any PT — in-network or cash-pay — and what to look for

Continue the conversation:
Instagram: https://www.instagram.com/dr.coach.kelseydpt
Monthly Newsletter: https://www.anteaterptp.com/newsletter
Episode topic requests: email podcast@anteaterptp.com 

Transcript

SPEAKER_00 0:07

Hello and welcome to Candid Conversations with Dr. Kelsey. I'm your host, Dr. Kelsey, and this is the space where I share my honest thoughts, real experiences, and the no BS conversations I wish more people were having about movement, training, injury recovery, and life as an active human. The goal of this podcast is to help you better understand your body, think more critically about rehab and fitness, and feel more confident making decisions so you can stay active long term. Before we start, a quick reminder. I am a physical therapist, but I am not your physical therapist. Nothing here is medical advice. So if you're dealing with something specific, please reach out to your PT or schedule a session to work with me. Alright, now let's get into today's conversation. So today I want to talk about something that a lot of people don't think about, and that's whether your insurance is actually saving you money when it comes to physical therapy or whether it actually might be costing you more than you realize. And so all of this came about because um we like about a month ago, um, we had about a month left to use our dental benefits. Like they were gonna run, we were gonna lose our benefits. And so um we decided to, you know, actually use them. Like we'd be we'd been paying into it, so time to finally actually use our benefits. Um and finding an in-network dentist with our dental insurance ended up being such a hassle that by the time we finally found one, my husband really wanted to maximize what we can get out of the insurance while we still had it. Um, so we ended up using them even though I wanted to go to a different dentist that I'd used before and actually liked, but they didn't take our insurance. So I went in for my yearly checkup, knowing that I was also dealing with some tooth pain on the bottom right. So at my checkup, the dentist has some trouble figuring out like which tooth on the bottom right is specifically causing my problems. But she does tell me that the second molar on the bottom right has a crack and will need a crown, and that the crown on the third molar needs to be replaced because apparently it's leaking or something, and then there's like a cavity underneath. Um, but um there's also a cavity kind of like on the side of that same tooth, like under the crown. So she thinks that um it might need a root canal, but she can't be sure. So um, so she's saying, you know, maybe just replacing the crown can be enough. And then she also mentions that at least one of the crowns that I have on the top um is also leaking or something and needs replacing. So um at this point, I uh I'm like, okay, I guess it makes sense that I need a crown on like that middle tooth because I have like so many other crowns because they're from like old fillings or something, and then a previous dent. So I'm at a it's this is a dental chain, and I've been to another dental chain who like in hindsight seems to push crowns a lot as well. Um, and so but I didn't know all of this at the time. Like I I know this after the fact. But um to me, I'm like, okay, well, I guess it makes sense that because that tooth has you know a big filling or whatever, and that's the reason why I needed to get crowns for my other teeth, so that kind of makes sense. And then replacing the crowns though seemed weird to me because all of my crowns are less than five years old. Like the oldest one that I have is like on the top, and um, I got that like during my last year of PT school, so it was around like five years ago. So um, so yeah, that was kind of weird to me because I was like, aren't they supposed to last like 10 years? But either way, I decided to go ahead with getting the two crowns on the bottom anyway, and then um even with the stupid dental insurance, I still needed to pay like a thousand dollars out of pocket for the two crowns, which I mean I guess it's not terrible considering I've paid like $700 for one crown before. Although that was for like the same day like the C Rec ones. Um, but the ones that I got this time are the ones that they send uh to a lab, so it took like you know, they do the buildup and it takes like two weeks, and then you go back and get the permanent crowns. Um, but anyway, so I go for the crown buildup, and after the anesthesia wears off, um I start having a lot of pain. And at first I think it's because, you know, oh it's like after my other crowns, like it was a little sore or whatever, and so maybe this time it's more painful because I had two teeth done at the same time. But after a few days, the pain starts getting significantly worse, and it's starting to like wake me up and prevent me from falling asleep um without taking pain medication. So at this point I'm taking ibuprofen like regularly. Um, when with my previous crowns, like I never had to take pain medication. So I figured, okay, well, the dentist did say I might need a root canal, so this is probably a sign that you know, worst case scenario, I do need a root canal now. And so I call the dentist's office and say I need a referral to the endodontist because I think the dentist was right and I need a root canal. So um apparent so this is again, this is a chain, and so I guess their endodontist like goes to different offices, like locations in the Vegas Valley, and so unfortunately the ones she goes to are like all on the other side of town. So I have to drive like half an hour to the appointment. Uh and but when I get there, I like wait another hour because these trains are terrible at scheduling, apparently. I don't know. Um so I'm already kind of like this like I've spent a lot of time here. Um but she finally sees me and then she does like the the test stuff and then um tells me that um yeah, though the the third tooth, that third molar, does need a root canal, but the other tooth that got the crown buildup also needs a root canal, apparently. And because and there's like a crack, like a small crack, I guess. And um because of that, she might have to extract it instead. And um, and then she's like saying, Oh yeah, and then there's like two teeth, so you you know, twice the amount of time in the dentist chair or whatever. And then at this point I'm like, this is way more than I bargained for. Like, I mean, all this is internally, but like in my head, but like I don't know, I like as before the initial check, like the initial visit, the checkup, I was having like minimal pain. So I knew like I would maybe need something because I I was having some pain. But now it's like, okay, now I find out I have to get like these two major procedures, and like I'm in more pain than I was before. And and I'm thinking also, okay, if if that tooth has to get extracted, because it's the one in the middle and it's on the bottom, like I can't just leave it. Um, like I would have to get like an implant or like a like a bridge, I think, or whatever, because like it's you know, you have to chew on it. So so then it's like even more things that and then like thinking of peop someone like drilling into my jawbone, I was like, no, thank you. Like I was like, I no, like I'm not I'm not gonna accept this right off the bat. Um so yeah, but and like I've I have all this time to think about this because like you know, because you know when you go to the dentist and then you have to like wait for the person to come back and be like, here's how much things cost. So like I'm like waiting, and I'm like waiting for another half an hour because my insur or the dental insurance we had was so terrible and complicated that they couldn't even figure out what my um what the estimate would be. So I'm like, okay, just call me, please. So I'm like, I don't want to be here for any longer, like because it was like lunchtime, I'm like hungry, I've been here for like two hours already. So um, so yeah, I leave and I'm like, you know what? I'm gonna get a second opinion because like this doesn't feel right. Like, I don't even if the second opinion tells me I need to get both, like at least I went somewhere else. So um I message um a colleague from my old gym who I knew was an endodontist, and at least I knew his office was close by where I lived. So um, so yeah, I make an appointment, and this experience was so much better. Like his office either blocks off time like directly for patient consults, like they don't just schedule people like during procedures, either that or he's just a lot better at managing his time or something. I don't know. But like I was in and out in under an hour, like, and that includes like taking the imaging and then him like doing his exam thing and talking to me and stuff. Um and oh, and so with the original endodontis, like when I'd gone, because I was taking ibuprofen frequently, like regularly, and so um I so there was like less pain probably, and then that's probably why she couldn't determine which tooth it was, I guess, that was causing the pain. Um, but then when I for the my colleague, the sec the second opinion, like he he did ask me, he's like, hey, when's the last time you took ibuprofen? And I was like, oh no, I took like right before I came here. So like not thinking. Um so he was like, you know, i sometimes it's hard to tell which tooth it is because you took, you know, pain medication and it's masking your pain. So like so I ended up going back the next day, like without taking pain pain medication for a while, so that he can really tell, like, determine which tooth it was. Um but so yeah, he determined that like that third molar was the one causing my pain. And so that one definitely needed a root canal. Um, but the middle tooth with the crack didn't really need any other intervention right now. Um, I mean it had the crown buildup, so it needs the permanent crown. But like he said, like he, you know, explained to me, like, you know, because as the crack, like I might need a root canal in a few like six months from now, but it's not something that I urgently need to get right now or extract. There's like nothing to suggest it needs to be extracted, like it's just something that I can monitor and like um you know, if if I have issues later, then we'll address it, but like not something that I need to deal with now. And so I felt so much better. Um and yeah, scheduled a root canal with him, paid out of pocket because I was like, I'm not dealing with that with insurance stuff. Um, and I mean it was pretty, I don't know, I thought it was reasonable compared to like cost, like looking up stuff up online, like I'm like, yeah, it's you know, it's what I expected to pay. Like it wasn't like ten thousand dollars or anything. So um, so yeah. So got the root canal, um, and then the next day or got the root canal and then um it's like weird to say, but like out of because I've again I've had like I think like five or six crowns done. Like I've had a lot of dental things over the years. Um by far root canal is by far like the biggest Well, I I don't want to say that's the biggest procedure besides so besides my wisdom teeth getting taken out, and I had I did have to get like five teeth pulled um before I got braces, because I guess my teeth are too big for my mouth or something. I don't know. But besides those two, like I which I'm pretty sure I well definitely I was put to sleep for the wisdom teeth. I don't remember for the the other teeth. But anyway, um like getting a it sounds weird to say getting the root canal was probably the best dental-related experience I've ever had. So at least in the last few years. So so there's that speaks about him and his work. Um and then when I went back to get to the original dentist to get the permanent crowns, um, even she was impressed by his work. So it wasn't just me being like biased or something. So um, so yeah, so get the permanent crowns, uh get the root canal, get the permanent crowns the next day, and then I'm like, okay, phew, like this is the end of my dental drama that I've been dealing with for like almost a month. Um, but then a few days after the permanent crowns um go on, like I start having tooth pain again, but this time it's different. Like it's we it's like this dole ache, but it's on different teeth. It's on the top teeth and um like another tooth on the bottom. And then so I start freaking out again because I remember that first dentist mentioning that I might need um another crown replaced, so I'm just like freak like I'm getting mad because I'm like, oh my gosh, did like the one that I got the crown from like a few years ago do a bad job or something? Because I'm like, these are supposed to last for like 10 years. Um and then I'm just like because like money is I don't want to say money is tight right now, but definitely like spending a thousand dollars here and a thousand dollars, like that's not something that we can really do. Um, right? I guess most people can't really do that, but like we definitely don't want to be spending more money, and so I'm like, oh my gosh, I'm gonna have to get another spend another thousand dollars for this freaking crown, and then um so I don't know, I'm like getting myself mad, and then the pain's not going away. So I end up going to um instead of going back to that original dentist, I go to another one. So this was a dentist that was recommended by my endodontist colleague actually. I'd gone to them before, but I didn't the reason why I didn't go to them this time is because they didn't take that stupid dental insurance. So I go to them and I pay out of pocket because I'm like, I'll just pay out of pocket. Um so yeah, she does x-rays, she checks all of my teeth, not just the ones that hurt. And then she's basically like, there's nothing wrong with my teeth. Like, okay, what like maybe one of the crowns on the top, like the I guess the margins look kind of weird or something, but it's not it's the seal is still there, and it's not do it doesn't seem like it's causing anything right now, and there's no cavity underneath. Um, so there's no reason to replace that one. And and it's on the other side, so it's not the the um it's not the one causing pain. So I was like freaking out about it, but it wasn't um yeah, I there's nothing to freak out about. And then she um bay for m the pain that for the teeth that are painful, she says that um she asks if the when they put the permanent crayons on if they did a bite assessment, and I'm like, I don't think they did. And so um, so yeah, she does the bite assessment and then like does the adjusting and stuff and like the shaving and whatever. And then um, yeah, my teeth feel so much better, like right away, basically, almost right away, like a few minutes, you know, yeah, things have to settle, but like that night, like I have zero pain. Um so yeah, it was I was like it was such a relief, like only paying like compared to me thinking I would need to p spend another thousand dollars. This was a fix that I mean arguably should have been free because the other dentists should have like done the bite assessment. Then I wouldn't have had to get the second opinion, but at least I only had to spend compared quote unquote only had to spend $150 to get this done and get reass reassurance and stuff about the rest of my teeth, versus spending a thousand dollars on a crown that I didn't need. So all this to say, uh, well, after this, then now for sure my dental drama is over. At least for now. I'm sure I'll have dental drama again in the future. But for this particular instance, it's over, like it's been a week or so, and like my teeth are fine. So I feel like it's resolved for now. But um, all of this to say it's like we we wanted to use our insurance because we're like, okay, we had been paying into it, like might as well use it, um, because at least they'll cover stuff. But at the end of the day, I still had to pay a thousand dollars out of pocket. I almost underwent treatment that I didn't need, and which would have been even more money out of pocket. And so it just kind of comes down to like sometimes using your insurance doesn't isn't in your best interest. And that leads to the sunk cost fallacy in healthcare, and especially with physical therapy. Um because at least with physical therapy, it's one of those things where uh like the worst that can happen is that not is that nothing happens, basically. Like you don't get better. Um, which, yes, like if you don't get better, like it can lead to other things down the line, but it's not like with this whole dental situation where it's like, well, the worst that happens is like I get all these procedures done, and it like costs a lot of money. Um but basically when talking about like the sunk cost fallacy with like insurance, is that like okay, you've already paid all of your premiums, and so you're kind of like mentally and I guess a little financially, but like mentally invested into like using your insurance for care, which is totally reasonable. It's a hundred percent reasonable, like that's the whole point of having insurance, but sometimes it's not in your best interest. Um and even if it's clear that it's not working, like that it's not serving you, like because we've spent all the money on the premiums, you're like even if it's not working when it's not when you're already invested in it, like you continue to try to make it work. Um and so for again, for physical therapy, like I mentioned, it's like, okay, well, you're paying your monthly premiums, um, and so might as well use your insurance. So you go somewhere that's in network and it's like a $50 co-pay or whatever, and then you're like, oh, well, that's you know, but uh compared to like a cash pay PT, like my rates for in-person is gonna be like a $200, $200 for the first visit. Um and then I don't do like um and then after that my model is a little bit different than like a traditional, like then sessions, but at least like you know, two fifty fifty dollars per visit is obviously a lot cheaper than $200 for that first visit. And so like people see that and they're like, well, it's a lot, you know, it's it's like yeah, maybe like it will get better value going cash pay, but like I'm already paying for my insurance, so I'm I might as well use my insurance. And especially if your deductible is bet and you don't even need to pay a copay, um, sometimes it feels like you're getting a physical therapy for free because you've already like basically prepaid and you're not paying additional costs. Um but if you're going like so besides the the not paying extra costs, like even if you're paying a cheaper copay, you have to still do the math because let's say you go for 12 visits, it's like, yeah, you're paying $50 each time, but then and or let's say you had 12 visits and you don't really get better, but you're like, well, at least it was only like $50 compared to like $200. But then if you add it up, like f 12 visits times times $50 is $600 out of pocket, plus all the hours of your life that you spent driving to the clinic and doing and doing stuff at the session that didn't end up helping you, plus not getting better. So like if you're going three times a week for four weeks for a month, then you just spent an entire month kind of wasting your time and wasting $600 plus if they like bill you for additional stuff, like at the I don't think it's balance billing. I have to look up what balance billing is. But like sometimes, like if you haven't met your deductible, you know, there's still some extra that wasn't covered. But anyway, but yeah, so if you think about it, if you didn't get better, then you just spent all this time and money not getting better. Um versus if you go somewhere like uh like for my model, for example, okay, you get that you pay the $200 at the first session. Most um, not just me, so most cash pay aren't going to have you come multiple times a week because it is more pricey. So they're gonna have you come like once a week. Um and they're typically gonna pay a little bit more. And I say typically, um, because I will mention later, like not all cash pay is better. Um, but but anyway, it's like even if it seems more expensive, you might end up getting more value for less money. And I know for me, it ends up um coming out cheaper because like for one month um for like the original, like the initial session plus the month of extra like the programming, your rehab plan and everything of exercises and all that stuff, for one month it will come out to a total of $280 versus. versus if you went for 12 and it's like a lot less time. It's more efficient because you don't drive into a clinic and stuff. So for me, it's $480 versus you paid $600 for 12 visits if if you had a $50 copay with your insurance. So it's like sometimes you have to do the math to see like how much you're actually paying if you're using your insurance. And a lot of this happens because insurance-based PT will have like the constraints of it's called volume-based care, where it's like the person who's making the decisions is looking at it from a business point of view, which is not inherently evil. Like, you know, you do still have to keep the lights on, you do have to pay rent for the clinic, you have to pay for your administrative staff, you have to pay your clinicians, you know, you have to pay for all of this stuff. So like money has to be made somehow. But it ends up becoming this balancing act of trying to like make money while also providing quality care. And it is possible to provide quality care in the insurance-based PT world. So I'm not saying that insurance pays PT is bad and cash pay is great. It's just there's more constraints in the insurance PT model. And it causes like limited one-on-one time and like pressure to fill up a schedule and like have you come back multiple times because that's the only reason that's how they're getting paid. And again this doesn't mean every end network PT is bad. It's just the system especially for athletes the system isn't designed to help people like you who are highly active and want to return to things like triathlon or CrossFit. It's excellent for maybe like the classic when people think about physical therapy like your grandpa who like is having some hip pain or whatever and like you know maybe isn't super active. So again I'm not talking about the super active grandpa's I'm talking about the ones that just like watch TV or whatever. So like those N-Retwork PTs are excellent for them. It gets them better and you know and everything but for people who want to get back to higher level stuff like the current model doesn't really help them very much. I think I've touched on that in my first podcast episode when I talked about why I left and started my own practice but um I'm not going to get more into it in here. But there um some of the parallels between this is so going back to the dent like the dental model so when I went to that the second opinion so this second opinion place for the the dentist um they are a private practice so it's like you know they own it the there's two dentists and that's it. And they were essentially telling or actually it was the assistant that was telling me that a lot of the chains will push crowns on people because that's what makes money. So they're pushing these things that you don't necessarily need. Like you kind of like is it's not like they were pushing crowns on healthy teeth. Like they were teeth that had old fillings but but they were pushing me to get crowns that I didn't necessarily need at that moment. So same thing for physical therapy is sometimes like I remember when I worked in a clinic sometimes I would get pressured to have people come back for more visits even though I'm like okay well they got better at six visits but they're like hey we need you to try to keep people for at least eight visits. And then even with their exercises I was too efficient so I would get scolded a lot and like because they would be done after like 30 minutes. I'm like okay I guess they're done I would get pressure to try to um prolong their session 40 minutes because then we can bill like four units instead of three units of time and get paid a little bit more. And then so it's like okay well then I have to like try to like stretch out the time that they spend in the clinic doing their exercises. And so again obviously it does sound sketchy but it's like it's on the margins of sketchiness. Because there are definitely other ways that uh some clinics do sketchy things but uh if the clinic I was working at was like one of those I would have left a long time ago. But we were definitely like kind of on the edge on the margins of trying to balance that stuff. So um like I mentioned not all insurance based PTs are bad. One of my friends she broke her ankle and ended up going to she used her insurance um to go to physical therapy and like they helped her and everybody in the clinic I mean I think again sometimes there's a difference between like the chains and the privately owned um like small clinics. But yeah like everyone at the clinic is actually active and like her physical therapist actually helped her return to CrossFit or to running in CrossFit. So like you know she actually got help. And um same thing for me. I know the VA has like a bad reputation VA healthcare system but I've gotten uh physical therapy at the VA and have gotten good results. They like helped resolve my neck pain twice so and I didn't have to pay anything um out of pocket for that. And I've also been to a cash pay PT who was essentially useless. Like I I went there to for like a foot issue with running and I don't know somehow even though I told him like okay this issue is with running and now it's starting to affect like box jumps but it wasn't the box jumps that crossfit that was causing my foot issue. It was the fact like I would run, have the foot issue and then the pain would start lasting and then when I do something like back squats or not back squats, uh box jumps or something, it would be painful because like the pain would get worse because it was there was already pain. I don't know he fixated that on that or something and then like spent an entire session quote unquote teaching me how to do box jumps and back squats, which I had zero issues with um and needed no I mean like he was giving me cues but I'm like I didn't need to like he was telling he was teaching me quote unquote how to do them but then like I would just do it and he didn't need to give me any more cues because that's not the problem that I was having. I didn't have any foreign problems with those things. But anyway so yeah he was terrible I never went back to him again because I'm like you're not helping like my problem is not with squatting and jumping like you're telling me oh yeah you need to be able to do these things like he was giving me an explanation but it was not relating to what I was there for which was to be able to run without pain. And so that kind of brings me to how to tell if your current physical therapist is actually helping you versus not helping you. Because again it sometimes using your insurance there's like an illusion that you're getting you know it's already paid for or that it's like free or whatever. But then you're still even if you're not spending more money you're spending more time and and I don't mean just the time like going to the clinic and coming back the time spent in the sessions it's like you're wasting the time spent that you could have spent getting better and now you're just delaying your care if like you're spending four, six weeks or even longer doing something that's not actually helping you. And I recognize that not everyone has the option to pay out of pocket like I did with my dental stuff. So if insurance is your only realistic path like that's completely valid. But like I mentioned like this isn't necessarily um getting a second opinion isn't only limited to going somewhere that's cash pay. Yes with insurance sometimes if you if you do get another an assessment for the same thing your insurance probably won't pay for the second assessment at the other place um but they might pay for like your care after but I know it I know it does get complicated but then you have to just kind of think about like okay do you want to get better faster and then kind of deal with the complications or do you want to just get this mediocre care and not get better and then like have that lead to you know other things down the road. So there's that but then but if you do have the flexibility like I did and again if your current PT isn't helping you like staying just out of habit or because you don't want to deal with it or because you have that sunk cost thinking that like well you already paid for it like might as well continue. Like yeah you have to remember again it's not actually helping you with anything it's not saving you money it's not saving you time it's not saving you effort by just staying with somebody that's not helping you. And so that brings me to like how do you know if you should get a second opinion and sometimes this can be tricky um especially like early on like you don't want to because sometimes it takes four to six weeks to see measurable changes but like you know I don't want to tell you like you gotta go for like a month to see if like you know if anything's changed because again if you're going three times a week and spending $50 each time like that that can be like six hundred dollars. So when when it comes to like measuring progress like you know if you if you don't see any changes in like one and two visits that that's almost meaningless. So instead of measuring like progress like that you're gonna look at the process that your physical therapy or your physical therapist is using. And again this is going to apply to both insurance based and even cash pay. So just because he goes to a cash pay clinic doesn't mean you're gonna be getting quality care unfortunately like I wish it was this cut and dry on that but it but it's not um so to evaluate the physical therapist like first you're gonna ask like ask yourself like okay so does this physical therapist know what you want to get back to? And even if like for example I've had patients who play hockey and I'm like you know I know very little about hockey but like I do my best to find out okay what exactly do they need to get back to like what at least what are the motions that they need to get back to like what motions make up like the thing that they need to do in their sport or whatever activity they want to get back to. So one does your PT know what you want to get back to? Two can the PT explain their reasoning behind each exercise that they're giving you and are the exercises actually working towards your goals because when I went to that one cash pay guy like he could definitely explain the reasoning behind doing the stupid box jumps and the squats but those exercises weren't really working towards my goals because I was already doing box jumps and squats. So like doing more of them it wasn't going to help me get back to running without foot pain. So your PT needs to be able to explain the reasoning behind the exercise and the exercises you there it has to be clear how those exercises are helping to get you towards reaching your goals. Three is the plan adapting as you go and with that if things are staying the same does the PT give a reason why because your plan is not necessarily going to change every single week. This is especially true for things that take a little bit longer like like a tendonitis type of thing like a tendon issue but if they're not changing your plan like they need to be able to give you a reason why um and this comes in a lot with clinics that um share patients so the ones where you're seeing a physical therapist but it might not and it might not be the same physical therapist. And sometimes it's hard to distinguish because some some clinics have physical therapy assistance um so you'll like you'll see the P T for the initial visit and then you'll see the PTA for the visits after um or some people get confused with the AIDS like AIDE S which those people are not licensed at all. So there's a difference between the assistant and the aide. So sometimes you're seeing multiple people and so depending on who the clinician is like it can lead to people's plans not progressing like staying the same because like they don't really know what's going on with you and then so they're like well this plan seems good enough and then so they have you do the same thing over and over again. So that's different than or because that's different because they're gonna if you ask them for a reason they're probably gonna be like oh well everything looks good like whatever like they'll give you kind of like a brush off answer versus like if there's a reason why nothing changed it's gonna be like okay well like these exercises were you mentioned they were challenging, they weren't too easy um or and so we're gonna still stay here a little one more week before moving on to something a little bit more difficult. Or maybe it was like oh well last week we tried this but then it flared you up a little bit so let's like stay at this level for another week um to give things a chance to calm down before progressing your exercises. So there should be a reason. So your plan should be adapting but if things stay the same there should be a reason why um and again even with like things that take a little bit longer like tendonopathies like tendonitis uh tendon issues like there might there's still gonna be some little tweaks here and there um like after every few weeks it's not gonna be exactly the same for the whole like six to eight weeks or longer so so anyway these so those are the questions that you're able to answer basically from the very first visit. Maybe it'll take two or three visits to kind of like get a sense of how the clinic is working or how the physical therapist is but there are things that you can ask and assess without having to wait like the four to six weeks to know if you whether you're you're getting results or not. Because you still need to be feel like the person knows what you want and is going to get you to your goals. Like you shouldn't feel like they're just kind of um which McCall it you should um it shouldn't feel like the person is using their own biases instead of helping you work towards your goals. And so with that I know getting a second opinion can be hard um and it also feels weird like you feel bad um you you know you don't want to be insulting but it's your body um you know getting a second opinion like you don't necessarily owe this person any loyalty um so and you would do it for any major expense right like if you had to and I and again you're not spending thousands and thousands of dollars on physical therapy but even like hundreds of dollars like if you had to get something repaired um on your car or in your house or something and it costs like 500 or more dollars you'd probably get a second opinion or multiple opinions um so I mean it's the same thing with physical therapy um so yeah at the end of the day regardless of insurance so whether it's insurance based or cash pay um arguably you know giving because cash pay you know it it can be a little bit more money so just so like keep an eye on it a little bit more but regardless of insurance uh you want your in you want your physical therapist to be able to give you an individualized plan, be able to communicate with you clearly have like be goal oriented and make sure those goals are aligned with your goals and are not just random ones that they made up based on their own biases and are willing to explain their reasoning because I mean like there's a reason why there's a reason behind everything that I do. Like I'm not just doing random things just because or I'm not like you know just giving someone like a cookie cutter plan. Like I'm I'm looking at the person in front of me and thinking through all the things that they want all the things that they need to do to get there and making their plan from that. So this applies to all physical therapists whether they use insurance or they do not um so key takeaways here just because your insurance is covering something doesn't mean that it might be the best choice for you. Like you have to also think about the time cost as well so not just the money cost but the time cost and also whether your recovery is taking the appropriate amount of time because um I've definitely had people um it just reminds me of somebody at my old gym who went to physical therapy after like an ankle like a really bad ankle sprain um and even after going for like three or four months like eventually he just kind of went back to CrossFit doing CrossFit um just by himself. And then he was like yeah and but we're still going to physical therapy and he was like yeah I'm doing harder stuff in CrossFit than I am in physical therapy and then I was like well then why are you still going to physical therapy? Because then then at that point it's like there's not really a reason to keep to go if and he was pretty vocal too about like hey why are we doing this? Like why aren't I doing this yet? Like why am I still doing this easy stuff? And um it seemed like he wasn't really getting any answers from the person and so he really got the sense that they were just trying to milk his insurance or something and eventually he did stop going there. But you know at that point it's like well if he ended up just kind of like going back to CrossFit on his own like was it worth going there to begin with you know so it's worth thinking about all of these things. And with that I know trying to find someone in network can be difficult to begin with and then with the insurance stuff like trying to get a second opinion can also be like a pain but you still have more agency than this insurance system wants you to think that you do. Like at the end of the day it's still your body so if whatever healthcare practitioner is not helping you you have you have the rights to go somewhere else and get a second opinion to make sure that you're going in the right direction. And lastly if something feels off about your care trust that instinct so like with me I'm like okay do I really need two root nails like I I don't know I like yeah I'm in a lot of pain but I feel like it's not like I didn't have that much pain before. So and then same thing for physical therapy. If you're going and you're like same exercises week after week after week and you're like I don't know this isn't really helping me probably trust that instinct and maybe ask either ask around maybe um like I've had people kind of ask me questions and even if they don't work with me eventually um I at least give them some advice and like some things that they can ask their physical therapist for because maybe that especially if that physical therapist isn't used to working with like a CrossFitter or something like they might not have thought of it. So um you know trust your instinct ask more questions get a second opinion if you need to so that's it for today. If you enjoyed this episode please consider giving my podcast a follow and leaving a rating to help others find this podcast. And thank you for listening and I'll see you in the next conversation