Why We Don’t Take Insurance at Formation PT & Performance
One of the most common questions we hear at Formation PT & Performance is:
“Why don’t you take insurance?”
Before opening Formation, we worked in traditional insurance-based clinics. We saw firsthand how insurance rules shape the way care is delivered.
Visits are often shorter. Therapists are treating multiple patients at the same time. And sometimes insurance companies decide when treatment needs to stop; even if a patient still doesn’t feel fully ready to return to the activities they care about.
We wanted to build something different.
Formation PT & Performance is a cash-based physical therapy clinic, which allows us to structure care around the patient instead of around insurance rules.
At Formation, every visit is one-on-one for a full 60 minutes with your physical therapist. That gives us time to listen, assess how you move, and build a plan that helps you return to the activities you love.
To help explain the difference, let’s walk through an example.
Two women in Richmond hurt their backs during workouts.
Both love group fitness strength classes and want to get back to lifting without worrying about their backs.
Both also have high-deductible insurance plans.
Many high-deductible plans require patients to pay thousands of dollars out of pocket before insurance begins helping with costs. Marketplace bronze plans, for example, average about $7,476 deductibles (yes, that’s how much you have to pay BEFORE insurance helps out).
Let’s follow Strong Sarah and Stuck Stephanie.
Strong Sarah vs. Stuck Stephanie
Week 1
Strong Sarah — Formation PT & Performance
Strong Sarah schedules an evaluation at Formation.
The first visit lasts an hour. We watch how she hinges, squats, and braces her core. We talk about her workouts and what happened when the pain started.
By the end of the visit, we’ve identified the likely cause of her back pain and built a clear plan.
She leaves with exercises in our app and a better understanding of what’s going on.
Stuck Stephanie — Insurance Clinic
Stuck Stephanie schedules an evaluation at a traditional insurance-based clinic.
The therapist doesn’t have much time to prep for the eval. The visit is shorter, and she leaves with a printed sheet of common exercises for back pain.
She’s scheduled to come back 2–3 times per week.
Weeks 2–3
Strong Sarah
Each visit is one-on-one for 60 minutes.
We focus on movement quality, strength, and lifting mechanics. Each session builds on the previous one.
If a question comes up between visits, Sarah can message her PT through the app, and gets an answer within the next business day - and often times even within a few minutes.
Stuck Stephanie
Stephanie continues attending therapy multiple times per week.
Because her deductible hasn’t been met yet, visits may average around $150+ per session.
Most of the exercises stay the same.
If she has a question between visits, she usually has to wait until the next appointment.
Weeks 4–8
Strong Sarah
Sarah’s strength starts to come back.
Her confidence improves.
She gradually returns to lifting again in a controlled way, with plenty of weight to be challenged.
Stuck Stephanie
Stephanie keeps attending therapy 2-3 times a week.
Progress is happening, but it’s slower.
She’s still unsure when she’ll feel comfortable returning fully to workouts, and the heaviest weights she has access to in the clinic are 10 pound dumbbells.
Around 3 Months
Strong Sarah
Sarah completes Formation’s 3-month program.
$866 per month
$2,598 total investment
She’s back in her strength classes and feels confident managing her back moving forward.
Because she’s feeling strong again, Sarah decides to keep working with us through our Continuity Program. Instead of focusing on rehab, we shift toward building strength, refining lifting technique, and working toward more challenging fitness goals.
Stuck Stephanie
Stephanie has now attended 20+ visits.
Before meeting her deductible, many visits cost around $150 each. After that, she still pays copays for each appointment.
By the end of the same 3-month time period, she may have spent $3000+ out of pocket.
Eventually, insurance may decide she has reached “functional improvement” and stops covering care, even if she doesn’t feel fully ready to return to lifting.
Because insurance-based therapy is usually focused on getting someone back to basic daily function, there typically isn’t an option to keep working toward higher-level strength or performance goals.
Stephanie is better than when she started, but she still feels cautious every time she picks up a barbell.
The Difference
Both women wanted the same thing: to get back to lifting without pain.
Strong Sarah received:
One-on-one care
60-minute visits
Strength-based rehab
A plan built around how she moves
Support between visits
At Formation PT & Performance, our goal is simple:
Help people in Richmond move better, lift stronger, and stay pain-free long term.
Not Sure if Physical Therapy Is Right for You?
If you’re dealing with back pain and trying to figure out how to safely return to lifting or group fitness, you don’t have to guess.
At Formation PT & Performance in Richmond, we offer a free 15-20 minute consultation where you can talk directly with a Doctor of Physical Therapy.
During that conversation we can:
Hear what’s going on
Talk through what might be causing it
Help you decide if physical therapy is the right next step
Answer any questions you have
If we think we can help, we’ll explain what the next step would look like.
If we’re not the right fit, we’ll point you in the right direction.
No pressure. Just helpful guidance.
👉 Schedule your free consultation here.