Why It’s Time to See Health Insurance Differently
When was the last time you paused and asked: Is my health insurance really looking out for me?
For many people—especially those seeking physical therapy, rehabilitation or whole-body health—insurance feels less like a partner and more like a gatekeeper. This post is about shifting your perspective on health insurance: not simply accepting the system as it is, but understanding the limitations, seeing how things could be different, and choosing a path that serves you, your body, and your family when you need it most.
Why Insurance Isn’t Always Your Friend
We hear it often: “Keep the insurance, just in case something major happens.” That makes sense on the surface—yes, a catastrophic event could bankrupt you. But deeper down? Insurance often is a faceless system deciding whether you are “worthy” of care, based on your diagnoses, age, condition, body part billed, network rules, etc.
The system was built around billing by diagnosis-code and body-part rather than treating the whole human being. It’s structured to pay when the threshold is met—not always to proactively nurture your movement, function and life.
So while insurance can provide value, it often falls short for people who want full, coherent physical therapy care, whole-body rehabilitation, and long-term resilience. Recognizing this is the first step toward reclaiming your health-care journey.
What Happens During Open Enrollment — And Why It Matters
Open enrollment is that annual window when you get to review your insurance, swap plans, or decide to make a bigger change.
If you don’t act during that period — unless a major life event happens — you may get locked into a plan that is not optimized for your evolving health needs.
At this decision point you’re not just picking premiums and deductibles; you’re choosing how your body, function, movement, rehabilitation will be covered (or not).
So it’s a strategic moment:
- Review last year’s care: what you used, what you didn’t, what “worked” and what didn’t.
- Ask whether your provider (say, your physical therapist) is in-network, out-of-network, whether you’re constrained by network or code billing.
- Compare costs not just in premiums, but in out-of-pocket, in access, in quality of movement care.
This is your chance to say: “Am I staying with this model, or am I looking for something better?”
The Traditional Model of “Sick-Care” vs. a Whole-Human Care Model
The dominant health-insurance system tends to treat parts: a body part, diagnosis code, procedure. For example: knee pain might be billed as “repair of M23.2” or whatever code. The schedule is dictated by whether the code is covered, whether the provider is in-network, whether the insurer approves.
Contrast this with a whole-human model: you’re one person, moving through life, with function, history, movement patterns, stress, trauma, lifestyle. The time you spend with your physical therapist should be the driver — the time, the quality, the focus — not simply the code or body part.
When the system bills by code instead of value/time/quality, you lose flexibility. You lose continuity of care. You lose true alignment with motion, wellness, rehabilitation, long-term functional outcomes.
And from the insurance side: you often become a “cost” — one more body part to be billed, rather than a person to be supported.
What Are Your Alternatives? Moving Away From “Just In Case” Insurance
Yes — catastrophic insurance is valid. You may absolutely decide to keep a baseline insurance that protects against major events. But that doesn’t mean you have to accept limited coverage, constrained provider lists, rigid billing models, or compromised physical-therapy care.
Here are some strategic alternatives and considerations:
- Maintain a high-deductible catastrophic plan, but for regular care (especially physical therapy) explore out-of-network options or membership-based practices.
- Ensure that when you need care (rehab, physical therapy, movement optimization) you aren’t forced into a system that treats you like a body part. You choose the provider, you choose the model (time‐based, value‐based).
- Ask your provider: “Do you carry insurance for your family?” If not, why not? (Many clinicians choose a different model for exactly the reasons we’re outlining.)
- During open enrollment, don’t just ask “Which plan has the lowest premium?” Ask “Which plan allows me to get the care I need when I need it—especially for movement, function, physical therapy—without constant gatekeeping?”
- Explore hybrid models: supplemental memberships, out-of-network cash-pay physical therapy, health share programs, direct care models. These aren’t for everyone—but for people seeking full body, full-motion care they may be worth investigating.
Subtle Advocacy for Out-of-Network Physical Therapy
We’re not making a hardline attack on insurance—rather, inviting change. Here’s how you think about it:
When you go out-of-network for physical therapy (or choose a provider who doesn’t rely on network constraints), you get:
- Direct access to the provider you trust, without “are you in network?” surprises.
- Treatment driven by time and quality, not simply by what code the insurer will reimburse.
- A model aligned with your movement, health and function—not just “approved services.”
- Less games with pre-authorizations, less mismatch between what you need and what the insurer will pay for. Yes, you may pay differently. But you may also get a much clearer value, better outcomes, more control.
For the provider, if they don’t carry insurance themselves for their family, that’s a meaningful signal: they believe in a different model—and maybe you should too.
A Call for Change—For You, For the System
Here’s where you come in. This isn’t just about finding a better plan for yourself—it’s part of a broader shift. Because when more people choose care models built around the human being, rather than the diagnosis code, the body‐part billing cycle gets challenged. The system evolves.
We invite you:
- During open enrollment, don’t just sign up for “whatever employer offers.” Ask the deeper question: Does this plan give me the freedom to see the provider I trust, to get physical therapy or movement care when I need it, and does it support whole-body health?
- Consider what your relationship with insurance is: partner or obstacle?
- Choose providers (especially physical therapists) who see you holistically, who value your time, your movement, your life.
- By making choices consistent with your values, you help usher in a new model—one where the current insurance paradigm cannot stand unchanged. It adapts, or it becomes obsolete.
Conclusion
Shifting your perspective on health insurance means more than picking a plan during open enrollment. It means recognizing the system’s limitations, protecting yourself (with catastrophic coverage if needed), but also actively choosing a care model that aligns with your values, your movement and your life.
For your physical-therapy journey, that means prioritizing access to care, treatment driven by time & quality, and providers who see you not just your body part.
Take a moment this open enrollment season: review your plan, ask the right questions, and make choices that empower you. Because ultimately, your health is worth more than a network. It’s worth the freedom to heal, move and thrive.
