A new JAMA Health Forum analysis highlights a growing issue every PT practice owner feels daily: patients struggle not because care is unavailable — but because their insurance is too complex to use.
Across 3,605 insured adults surveyed, nearly 60% reported problems using their coverage. For people with ongoing needs (aka PT patients), the number jumps close to 80%.
Their biggest barriers?
Confusing benefits, unclear costs, trouble finding in-network providers, and claim denials — all of which directly delay care and increase cancellations.
For PT clinics already battling shrinking reimbursements, this isn’t just a policy problem. It’s a front-desk, scheduling, and revenue-cycle problem.
Key Takeaways for PT Practice Owners
1. Insurance confusion = fewer completed visits
Patients delay or skip sessions because they don’t understand coverage, deductibles, or authorizations. This fuels higher no-show rates and incomplete plans of care.
2. Claim denials and prior auths are rising
The report shows denials and plan restrictions as a primary patient friction point. For PTs, this means more admin time, slower payments, and higher A/R.
3. Out-of-pocket surprises hurt trust
Over 25% of surveyed patients paid more than expected. When patients feel blindsided, they’re less likely to return — or complete care.
4. Complexity hits chronic-care patients hardest
People with ongoing conditions — a large portion of PT caseloads — face the greatest difficulty accessing care. They need navigation support, not more paperwork.
5. Simplification is now a competitive advantage
Clear benefits explanation, transparent pricing, and proactive insurance checks aren’t just good service — they are a growth lever for PT clinics trying to stand out.
What PT Clinics Can Do Right Now
- Automate benefits verification and give patients clarity before their first visit.
- Educate patients early on expected costs and visit limits.
- Reduce friction with clean documentation and faster PA workflows.
- Monitor payer trends to anticipate common denial reasons.
- Offer self-pay clarity as an alternative when insurance creates barriers.
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Get a DemoLegal Disclosure:- Comparative information presented reflects our records as of Nov 2025. Product features, pricing, and availability for both our products and competitors' offerings may change over time. Statements about competitors are based on publicly available information, market research, and customer feedback; supporting documentation and sources are available upon request. Performance metrics and customer outcomes represent reported experiences that may vary based on facility configuration, existing workflows, staff adoption, and payer mix. We recommend conducting your own due diligence and verifying current features, pricing, and capabilities directly with each vendor when making software evaluation decisions. This content is for informational purposes only and does not constitute legal, financial, or business advice.
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