Physical therapists urge Legislature to lower co-pays

Group blames high cost for dip in patients

Saturday, April 6, 2013
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— The New York Physical Therapy Association is calling on the state Legislature to prohibit health insurers from applying what the organization describes as disproportionately high co-payments to physical therapy.

Many health insurance companies require that patients pay a higher specialist co-pay for physical therapy. Michael Mattia, chair of the NYPTA’s legislative committee, said that this higher co-pay, which can be as much as $50 per session, can make it tough for patients to afford therapy, and more likely to forego needed treatment.

He said it is not uncommon for patients to undergo between 10 and 12 treatments a month, and end up paying $500 out of their own pocket.

“These co-payments make physical therapy unaffordable,” Mattia said.

Mattia also said it will eventually lead to more expensive health problems, as patients who skimp on physical therapy find themselves suffering from pain and mobility issues.

“If patients don’t come to us, somewhere down the line they’re going to need services,” he said.

For physical therapists, the consequence of higher copays has been a decline in patients, said Mattia, whose physical therapy practice is based in New York City. He said he was forced to cut an assistant.

Under the proposed legislation, the co-pay for physical therapy would be limited to 20 percent of the cost of care or reimbursement rate.

Leslie Moran, a spokeswoman for the New York Health Plan Association, said high physical therapy co-pays are not a problem, and are unlikely to become a problem.

“This is a bill in search of a problem,” she said.

Moran said that under the federal health reform bill known as the Affordable Care Act, the cost of co-payments will be set by new health insurance exchanges — state-based marketplaces where individuals and small businesses can purchase health insurance. Insurance plans not sold on the exchange will be subject to the same cost limits as plans sold on the exchange.

“The co-payments will be established by the health insurance exchange,” Moran said. “The legislature won’t be able to change that.”

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April 7, 2013
4 p.m.
RLXPrez says...

What else would one expect the spokesperson for the insurance companies to say? That they would welcome such legislation because they felt they were not paying enough of their customers financial burden for physical therapy? Unlikely. Anyone who has needed PT for an extended period knows that very quickly choices need to be made between the benefits of PT or the benefits of filling the tank with fuel.

After a month or two of weekly sessions the patient's decision is frequently, "I can find a way to live with the pain because I need to find a way to pay my kids college bill next month.

Thank you Ms. Foss for a good article. It could have been even better if it informed the reader of the typical PT fee for service and the reimbursement rate by insurance companies. It would be interesting to compare those amounts to that of our copay.

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