Breaking Free from Insurance: How Employers and Providers Can Cut Out the Middleman

Insurance companies, like UnitedHealthcare (UHC), make their priorities clear: profits come first, not patient care.

In the first three quarters of 2024, UHC reported $8.9 billion in profit—a staggering figure, even though it’s down from $16.9 billion in 2023. These numbers highlight a painful reality: insurance companies are not in the business of improving healthcare. They are in the business of maximizing revenue.

Every year, insurers pocket billions while patients struggle to afford care, providers face shrinking reimbursement rates, and employers pay rising premiums. This isn’t a broken system—it’s one designed to benefit insurers at the expense of everyone else.

How Insurance Companies Keep Profits High

To increase earnings, insurance companies strategically limit the care they pay for. They do this through:

• Prior authorizations – Delays that force patients to wait for approval before getting treatment.
• Claim denials – Providers must fight for payment, leading to wasted time and financial strain.
• Low reimbursement rates – Many providers lose money treating insured patients—as a result, over a quarter of PT practices reported going out of network with 20-30% of their payers.
• Visit caps and restrictions – Patients are forced to cut treatment short, even when more care is needed.

While these tactics reduce insurer payouts and improve profitability, they worsen patient outcomes and drive up long-term healthcare costs. When people delay or avoid care due to insurance barriers, they often require more expensive interventions later—which insurers then use as justification for raising premiums.

For physical therapists, the system is particularly brutal. Insurers dictate payment rates, limit treatment sessions, and bury providers in administrative work. The only way for PTs to break free is to stop relying on insurance reimbursement entirely.

Direct-to-Employer Contracts: A Better Alternative

Instead of fighting insurance companies for fair pay and patient access, many providers are choosing a different path: direct-to-employer contracts.

Why this model works:

• No prior authorizations or visit limits – Patients get the care they need, when they need it.
• Fewer administrative burdens – Providers spend more time on patient care, not paperwork.
• Fair reimbursement rates – No more undervaluing PT services.
• Lower costs for employers – Companies save by eliminating the middleman and investing in preventative care.

Why Cash Pay Alone Isn’t Enough

Some providers turn to cash-pay models to escape the insurance trap, charging patients directly for services. While this approach allows for greater financial control, it isn’t a complete solution.

The problem? Affordability. Many patients can’t pay out of pocket, especially when insurance has trained them to expect low-cost copays—even if those copays come with rising premiums, high deductibles, and limited coverage.

Cash-pay models work for some, but to make real change at scale, providers need to think bigger. That’s where self-insured employers come in.

How Employers Can Fix the Broken System

Self-insured employers—who manage their own healthcare costs instead of relying on private insurers—are in a powerful position to cut out insurance companies entirely.

Musculoskeletal (MSK) issues, like back pain and injuries, are among the top healthcare costs for employers. By partnering directly with PT providers, companies can:

• Lower overall healthcare costs by reducing unnecessary surgeries and imaging.
• Provide better care for employees without insurer-imposed restrictions.
• Ensure fair pay for providers, creating a sustainable healthcare model.

Instead of paying into a system that funnels billions into insurance company profits, employers can invest in direct care solutions that benefit their workforce. It’s not just an idea, either—75% of employers are actively having discussions about direct contracting with healthcare providers.

The Future of Healthcare is Direct

Healthcare doesn’t have to be controlled by insurance companies. By shifting to direct care models, providers, patients, and employers can reclaim control of the system.

• For providers, this means less admin work and fairer pay.
• For patients, it means easier access to high-quality care.
• For employers, it means cost savings and a healthier, happier workforce.

The solution isn’t waiting for insurance companies to change—it could be creating a new long-term plan that includes options outside insurance. Second Door can help with that—talk to us to see how to take control of your future.

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