Are Cash-Based or Insurance-Based Providers "Better"?

There’s been a recent flare-up in the pelvic rehab world around cash-based versus insurance-based care.

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There’s been a recent flare-up in the pelvic rehab world around cash-based versus insurance-based care. And while emotions are running high, we wanted to pause the noise and add something that feels increasingly rare: context.

In this episode, we start with what we all agree on:

• Every pelvic PT and OT is doing their best for their patients

• We all want clinicians to be paid fairly and sustainably

• More practice models = more options for both clinicians and patients

• Patients benefit from having real choices

• We should be referring to one another, not competing against the field itself

• The current medical system requires both insurance and cash-based care — in every country we’ve seen

From there, we address the two biggest areas of disagreement head-on.

First, the claim that cash-based practices reduce access to care. We walk through the data around deductibles, waitlists, and real-world barriers to care — and why more options actually increase access, not reduce it.

Second, the idea that one model inherently produces better care. We’re very clear here: you can get excellent or poor care in any setting. But when you take the same caliber clinician, the environment matters — and we explain why time, autonomy, documentation burden, and feedback loops change outcomes.

This episode isn’t about picking sides.

It’s about understanding incentives.

And it’s about recognizing that the growth of pelvic rehab depends on all of us moving forward together.

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Nicole Cozean, PT, DPT, WCS

Founder of Pelvic PT Rising and PelvicSanity Physical Therapy in Southern California.

Dedicated to forever changing pelvic health with online clinical courses to help you be more confident in your practice and business resources to help start and grow pelvic health businesses.

Jesse Cozean, MBA

Co-founder of the Pelvic PT Rising and the Rising Podcast.

Jesse uses his business experience to help pelvic health business owners start and grow their practices so they can build a practice that truly works for them. From website design, SEO, conversions, marketing, finance and money mindset, he wants to make the process of owning your own practice easier and fun.