Short answer: because the price of one visit is not the price of your care. What you actually pay for physical therapy is the cost per visit, times the number of visits, plus the hours you spend getting there. Cash-pay care often wins on all three.
Most people assume using insurance is automatically the cheaper option. Sometimes it is. But with deductibles where they are today, many patients pay full price for in-network visits anyway, and they pay it for more visits, with less time one-on-one with a physical therapist.
Here is how the two models actually work, what the math looks like, and why Strike Physiotherapy & Performance is out of network on purpose.
How In-Network Physical Therapy Gets Paid
An in-network clinic agrees to accept whatever rate the insurance company sets for each visit. That rate is usually lower than people think.
U.S. Physical Therapy, a publicly traded company with nearly 800 outpatient clinics, reported collecting an average of $107.59 per patient visit in the second quarter of 2026. That was a record high for them. Medicare, whose rates many commercial insurers follow closely, cut its main payment multiplier by about 10% between 2020 and 2025. The small increase in 2026 did not come close to undoing that.
Meanwhile, rent, salaries, and equipment keep getting more expensive. When a clinic is paid around $100 to $110 a visit, one physical therapist spending a full hour with one patient rarely pays the bills. So the model adjusts:
- More patients per hour. It is common for one therapist to overlap two or three patients at once, with aides or techs running the exercise portion.
- More visits per plan. Plans of care are often built around two to three visits a week for six to eight weeks.
- Less time per visit. Your time with the actual physical therapist may be 15 to 30 minutes of a longer appointment.
- Insurance limits. Many plans cap visits per year or require prior authorization before more visits are approved.
None of this is a knock on the therapists working in those clinics. Many of them are excellent. It is simply what the reimbursement model requires to keep the doors open.
Your Deductible Changes the Math
Here is the part most people miss: until you meet your deductible, you pay the full insurance rate for every in-network visit. Your copay or coinsurance only kicks in after that.
According to KFF’s 2025 Employer Health Benefits Survey, the average deductible for single coverage on an employer plan was $1,886. About a third of covered workers had a deductible of $2,000 or more. Family deductibles run higher.
So if you hurt your knee in March and have not had much medical care yet that year, “using your insurance” often means paying for most of your physical therapy yourself, just at the insurer’s rate and on the insurer’s schedule.
A Side-by-Side Example
Let’s put real numbers on it. This example uses the average deductible above, a per-visit rate in line with what large in-network chains report, and a common 20% coinsurance after the deductible.
| In-network clinic | Cash-pay, one-on-one | |
| Typical plan | 2x a week for 9 weeks | 1 to 2x a week |
| Number of visits | 18 | 8 |
| Price per visit | About $120 (insurer’s rate) | The clinic’s set rate |
| What you pay | $1,886 deductible + 20% of the remaining $274 = about $1,941 | 8 x session rate |
| Time with a physical therapist | Often shared with other patients | The full session, every session |
| Hours spent, including travel | About 27 | About 12 |
In this example, the in-network route costs about $1,941 out of pocket. Spread across 8 cash sessions, that works out to roughly $240 per session. If a cash session costs less than that, cash-pay is cheaper in dollars alone, before counting any out-of-network reimbursement and before counting the 15 hours you get back.
Your numbers will differ. Your deductible, your rate, and how many visits your condition needs all matter. But the structure of the math is the same for almost everyone: fewer, longer, more focused visits can cost less than more, shorter ones.
Why Fewer Visits Is Realistic
Fewer visits is not about cutting corners. It comes from what happens inside each one.
In a full hour with the same Doctor of Physical Therapy, there is time to properly assess how you move, treat hands-on, coach every exercise, progress the plan, and build a home program you will actually follow. The real change happens in the days between sessions. When the program is right, you do not need to be in the clinic three times a week to make progress.
Research points the same way. A study in Health Services Research looked at more than 62,000 episodes of outpatient physical therapy. Patients who went directly to a physical therapist, without a physician referral, used about 14% fewer visits and had about 13% lower costs, with no increase in other health care use afterward. At Strike, every patient comes to us directly, and most see meaningful improvement within 4 to 8 sessions. (More on that in Do I Need a Referral for Physical Therapy in California?)
The Costs That Never Show Up on a Bill
The invoice is only part of what physical therapy costs you.
- Your time. Eighteen visits with a 30-minute round trip is about 27 hours. Eight visits is about 12.
- Missed work. More appointments usually means more time away from your job or your family.
- Starting over. A rushed plan that stops when the pain fades, but before the root cause is fixed, often means paying for a second round months later. We explain why in How Many Physiotherapy Sessions Do I Need?
- Delays. Waiting on referrals or prior authorizations can push your first visit back by weeks while the problem gets more irritated.
Out of Network by Design
Strike Physiotherapy & Performance is out of network on purpose. It was a deliberate choice, and we made it because it is the only way we can deliver the care we believe in.
Being out of network means:
- One therapist, one patient, the whole time. Every session is one-on-one with a Doctor of Physical Therapy: 90 minutes for your first visit and 60 minutes for each follow-up. No aides, no being handed off, no splitting the hour with two other people.
- Your plan is built around your goals, not a visit cap. We decide how often you come in based on how you are responding, not on what an insurer authorized.
- No waiting to start. No referrals or authorizations stand between you and your first visit.
- Room to go past “pain-free.” We can take you from getting out of pain to fixing the root cause to performing better than before, because no one is telling us to discharge you the moment you hurt less.
- Clear, upfront pricing. You know what a session costs before you book. Check our current availability and pricing.
And being out of network does not mean your insurance is useless. Many plans, especially PPOs, reimburse part or all of out-of-network physical therapy. We give you the documentation you need to submit a claim, and you can pay with your HSA or FSA.
When In-Network Might Cost You Less
We would rather you make the right choice than the one that benefits us, so here is the honest flip side.
If you have already met your deductible this year and your plan has a low copay, in-network care can cost less per visit. At a $40 copay, 18 visits is $720. In that case, the question becomes whether you value one-on-one time, fewer trips, and a plan built around your goals enough to pay the difference. Many of our patients decide they do, especially after trying the other route first. Some decide they don’t, and that is a fair call.
Some plans, like many HMOs, also have no out-of-network benefits at all, so reimbursement will not be an option.
How to Check Your Own Numbers
A five-minute call to the number on the back of your insurance card will tell you most of what you need. Ask:
- How much of my deductible is left this year?
- What is my copay or coinsurance for outpatient physical therapy?
- Is there a limit on physical therapy visits per year, and do I need prior authorization?
- Do I have out-of-network physical therapy benefits? If so, what is the out-of-network deductible and what percentage do you reimburse?
- What do I need to submit to get reimbursed?
Then compare: your realistic in-network cost for a full course of care, versus a shorter course of one-on-one sessions minus whatever your plan reimburses. If you want help running the numbers, we are happy to walk through it with you.
Common Questions
Do you take insurance?
We are an out-of-network provider, so we do not bill insurance directly. You pay at the time of your visit, and we provide the paperwork you need to submit to your insurer for out-of-network reimbursement.
Can I get reimbursed by my insurance?
Often, yes. Many PPO plans reimburse part or all of out-of-network physical therapy once your out-of-network deductible is met. How much depends on your plan, so call your insurer and ask the questions listed above.
Can I use my HSA or FSA?
Yes. Physical therapy is an eligible expense, and you can use your Health Savings Account or Flexible Spending Account to pay for sessions at Strike.
Is cash-pay physical therapy worth it if I’ve already met my deductible?
It depends on what you value. In dollars alone, in-network may be cheaper at that point. What you get with cash-pay is the full hour with a Doctor of Physical Therapy, fewer trips, and a plan built around your goals rather than your benefits.
Do I need a referral?
No. In California you can see a physical therapist directly, without a doctor’s referral, for up to 45 days or 12 visits.
The Bottom Line
The cheapest physical therapy is not the one with the lowest price per visit. It is the one that gets you better in the fewest visits and keeps you from coming back for the same problem.
For many people, especially those who have not met their deductible, cash-pay physical therapy costs the same or less than in-network care, and comes with far more one-on-one time. That is why Strike Physiotherapy & Performance in North Hollywood is out of network by design.
Not sure which option makes sense for you? Book a free discovery call with a Doctor of Physical Therapy. We will talk through your injury, your goals, and your insurance, and give you an honest answer.
This article is for general educational purposes and is not financial, legal, or medical advice. Insurance benefits and costs vary by plan.
Sources Referenced
U.S. Physical Therapy, Inc., Second Quarter 2026 results (August 2026) — net revenue per patient visit of $107.59. Medicare Physician Fee Schedule conversion factor, 2020 ($36.0896) vs 2025 ($32.3465), as summarized by Physitrack (August 2026); 2026 average payment increase for physical therapy per APTA. KFF, 2025 Employer Health Benefits Survey — average single-coverage deductible of $1,886; 34% of covered workers with a deductible of $2,000 or more. Pendergast et al., Health Services Research (2012), A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy — 62,707 episodes; self-referred episodes had fewer visits and lower costs.
