HingeSelect: Same Script, Different Cast
From Virtual Exercise Therapy to Middleman Extracting Rates from Physical Therapy Providers
Preview: Remember when Hinge Health actually liked and used PT’s? That “friend of the profession” has now pivoted into a third-party administrator, steering patients to clinics at deep-discounted rates while pocketing high-margin admin fees. We’ve seen this movie before — Align, MedRisk, ASH — and it ends with lower reimbursement, more utilization review, and less control for PTs. Here’s why you should just say no, and how to educate employers on the real PT-first path to lowering MSK costs.
Fellow PTs and healthcare aficionados,
Grab your favorite AI note taker or scribe and take a seat — it’s time for some story time. You know how Hollywood keeps rebooting movies we didn’t really ask for? Well, the MSK benefits world has its own reboot saga, and the villain has a new name: HingeSelect.
But first, a little history lesson.
side note: for my prior writings on Hinge Health see
Virtual Health in Physical Therapy: Navigating the 2025 Landscape and Beyond, or
The AI Therapist Will See You Now… Or Will It?, or
New Smart Skills: From AI Panic to Human-Machine Powerlifting
Remember When Hinge Was Our Friend?
Cast your mind back a few years. Hinge Health hit the scene promising to be a physical therapist’s best buddy. The company built its brand around virtual physical therapy using actual PTs, shipping wearables to patients’ homes, and connecting them with coaches. It flooded employer benefit fairs with slogans like “100 % employer-covered” and “$0 cost to you”. For a time, it seemed like Hinge was on our side: high-quality exercise programs delivered remotely, no copays, and a constant drumbeat about engaging more people in PT.
Then of course was the pivot. From a technology company trying to do healthcare, PTs are just fungible commodities that only teach exercises, so Hinge became“digital MSK” or per their S1 disclosure, “virtual exercise therapy”. Employers, loved saying their workers could get PT from the couch. Unfortunately, the employees of these self-insureds, misled by calls to action, likely believed that a real PT was involved. While engagement of Hinge is actually quite low as a percentage, the fanciful marketing makes it attractive to think they are getting something for nothing, and as it has been said, nothing is more expensive than free healthcare, especially to naive employers and employees. Hinge’s client roster exploded to over 2,300 companies, with revenue up 55 % year-over-year. Some PTs who hadn’t been terminated when Hinge laid off 10% of its workforce in 2024, partnered with Hinge as virtual coaches, and they enjoyed flexible side gigs and thought of the company as an ally. But, low engagement in a point of service product that payors are generally fatigued around is not exactly a way to keep 2,300 customers, so how about a new strategy?
Then came the next pivot. In June 2025, Hinge announced HingeSelect, its shiny new “high-performance provider network” for musculoskeletal care . Suddenly, the company wasn’t just offering free virtual PT — it was building a narrow network of in-person providers, negotiating rates up to 50 % below PPO prices and promising employers end-to-end control over MSK care. The friendly façade gave way to a more familiar TPA playbook: triage patients digitally, steer them to contracted clinics, take an admin fee, and call it innovation. Thus Hinge is “digital MSK” masquerading as yet another foe to PT’s, best thought of as a combo of a TPA and Specialty Benefit Manager (SBM). Several months ago, I exposed the shenanigans of SBM’s in a two part series The Role of Specialty Benefit Managers: #PhysicalTherapy: Echoes from PBMs in the Pharmaceutical Industry Part I (and Part II). Now Hinge will make more money from HingeSelect by steering patients quickly off digital exercise therapy and into the hands of naive PT providers who sign contracts below their cost and let Hinge make more money off their visit than they get paid by the payor who engaged Hinge!
With that context, let’s revisit why this “new” model feels eerily familiar — and why we should be skeptical.
Introducing HingeSelect (a.k.a. “Old Wine in a New Bottle”)
According to Hinge’s own press release, HingeSelect is a “high-performance provider network” that plugs any gaps in their digital care. It doesn’t matter if any PT’s have yet to sign up because calling yourself “high performance provider” is table stakes marketing for those selling to self-insureds a combo TPA, SBM that is “new and digital”. If a member needs an MRI, injection or in-person therapy, Hinge’s in-house docs will triage them and “seamlessly” steer them to pre-vetted providers . The catch? Those providers must agree to bundled pricing up to 50% below PPO rates . Hinge markets this as “lower unit prices” and “predictable costs.”
If this feels familiar, it’s because we’ve seen this movie. In the late 2000s and early 2010s, third-party administrators (TPAs) like Align Networks and MedRisk promised payers cheaper PT. How did that work out?
Align Networks/One Call PT
A 2017 WorkCompCentral report described how Align changed its name, rolled out a new payment system and introduced a 3 % fee just to receive VCard payments. Providers were already accepting steep discounts, and DaisyBill warned that Align was “already taking a steep discount” and still making providers pay to get paid. A lawsuit by California PTs accused Align of steering injured workers only to clinics willing to accept the lowest reimbursement and pocketing the “spread” between what it got from insurers and what it paid providers.
I’ve been warning about this game for a while — in fact, I wrote about it back in 2014: Misaligned Network Heads I Win, Tails You Lose Approach to Physical Therapy.
For a look at how PTs have pushed back from WorkCompCentral, see PT’s Challenge to One Call and Align, and this past post from this newsletter about the lawsuit.
MedRisk
A 2025 DaisyBill article summarized an iPTCA lawsuit alleging that MedRisk contracts with insurers and TPAs to schedule injured workers with MedRisk-contracted providers, preferentially refers patients to the providers who accept the deepest discount, and keeps the difference. A California PT in that article bluntly called the arrangement “fee-splitting” or “kickbacks,” noting that MedRisk contracts “well below the [Official Medical Fee Schedule]” and pockets most of the dollars intended for rehab services.
American Specialty Health (ASH)
Similar story, different logo. Providers report rock-bottom reimbursement rates and aggressive utilization management under ASH contracts. Once you sign on, you get the double whammy: lower per-visit pay and more hoops to jump through.
The Red Herring of “Zero Copay”
Hinge’s digital program is indeed employer-paid with zero member copay . That sounds great… until you peek behind the curtain. On Reddit, one “free” Hinge user discovered that their insurance was billed $350 per session. Another commenter saw an $1,100 claim, while a third noted their insurance was billed $331 per month. Hinge loves to market “no copay” because it entices patients, but the insurer still pays — and HingeSelect will ensure more of those dollars pass through Hinge’s fingers.
Why PT-First Matters (and Why Segmentation Doesn’t)
What frustrates me most is that HingeSelect revives the failed strategy of siloing MSK costs. Chopping up PT, imaging, surgery and prescriptions into separate buckets creates perverse incentives to make each slice cheaper rather than reduce total MSK spend. Plenty of evidence shows that when patients start with physical therapy, overall costs and downstream utilization plummet including the below and some additional in prior post of this newsletter:
A 2018 Health Services Research study found that patients who received physical therapy early for low back pain had significantly lower total healthcare costs, with a 90 % reduction in opioid use, 28 % reduction in imaging and 15 % reduction in emergency room visits .
The same article notes that early PT reduces advanced imaging, physician visits, surgery and opioid use . (we have dedicated tons of additional evidence and links on this)
An APTA analysis of Medicare claims found that the average total medical cost when physical therapy was the first intervention for low back pain was $3,992, compared with $4,905 when injections were used first and $16,195 when surgery was the starting point; a 19 % and 75 % savings, respectively . Over a year, total spending for PT-first patients remained 18 % lower than injection-first and 54 % lower than surgery-first . Starting PT within 15 days of diagnosis lowered costs even further.
The American Physical Therapy Association (APTA) just released new data, and the results are hard to ignore:
$1,828 average savings for patients who choose Direct Access to PT.
40% fewer imaging orders.
40% fewer opioid prescriptions.
40% fewer injections.
65% fewer follow-up visits compared to physician-managed patients.
$1,828 average savings for patients who choose Direct Access to PT.
40% fewer imaging orders.40% fewer opioid prescriptions.
40% fewer injections.
65% fewer follow-up visits compared to physician-managed patients.
In other words, the way to lower MSK costs isn’t by squeezing PT rates — it’s by making PT the first stop, paying providers fairly, and avoiding unnecessary imaging, injections and surgeries. I have personally presented data three times at national meetings which showed the best savings for a self-insured plan is when the plan design waives copays if PT is the first encountered provider in a MSK episode as that seriously diminished pharma, surgery, and imaging costs because chances are high that most MSK cases can be handled in totality by PT’s.
What You Can Do
Just say no. You are not obligated to join HingeSelect. Align and MedRisk taught us that once you sign up for deep discounts, it’s nearly impossible to regain leverage. Keep your rates sustainable and don’t give away half your revenue for the promise of “volume” or being part of a “digital AI revolution in healthcare”!
Educate your employers. Self-insured companies love the sound of “50 % below PPO.” Show them the real math: early PT saves money and avoids costly surgeries and imaging . HingeSelect’s “no copay” carrot simply shifts costs to insurers and puts Hinge in the middle. Encourage employers to offer PT-first with a zero copay and fair reimbursement to providers — that’s where the true ROI lives.
Watch for utilization review creep. Networks like Align, MedRisk and ASH often pair low reimbursement with intrusive utilization management. Expect more hoop-jumping for authorizations while Hinge pockets its administrative fee.
Demand transparency. Ask Hinge for the exact reimbursement rates and the size of their admin fee. High-margin middlemen thrive in shadows.
We’ve been here before. The names change — Align, MedRisk, ASH, now Hinge — but the playbook stays the same. Don’t let slick marketing about “digital”, AI, and zero copays distract you from the underlying business model: steer patients to a narrow network, pay providers less, and extract a fee from every visit. As the saying goes, “Same script, different cast.”
Stay informed, stay united, and keep fighting for fair payment and evidence-based care. And if a tech bro comes knocking with promises of “free” PT and “high-performance networks,” tell them politely: “We’ve seen this movie. No thanks.”
larry
@physicaltherapy