Plan designed to help inform decisions about physical therapist services in insurance plans
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Alexandria, VA, March 28, 2012 — The American Physical therapy Association (APTA) has recently adopted the Physical Therapy Model Benefit Plan (MBP) Design, to help inform decisions made by insurers, employers, individual insurance plan subscribers, and public policy makers regarding access to and coverage of physical therapist services in insurance benefit plans.
The MBP includes a description of the role and value of physical therapists in health care that emphasizes the use of evidence in reducing disability and clinical costs, guiding principles for access to physical therapists, the role of medical necessity in decision making, the coverage of physical therapy benefits, and appropriate cost-sharing provisions. Physical therapists can use the MBP to advocate for appropriate access to and coverage of physical therapist services.
"The physical therapy profession exists to promote optimal health and function," said APTA President R. Scott Ward, PT, PhD. "Access to physical therapist services is an essential component to helping patients achieve optimal movement, and thereby optimal quality of life."
In some markets, out-of-pocket payments account for the majority of the costs of a physical therapist visit. In some instances, multiple copayments are required for a single visit, on the same date of service, under one physical therapy plan of care. According to Ward, "APTA appreciates the concept of cost-sharing to encourage appropriate utilization of health care services, but out-of-pocket payments are getting to the point where patients are choosing to forgo vital services."
Physical therapists provide evidence-based services to decrease disability, improve function and independence, prevent illness, promote wellness, and restore quality of life to the patients/clients they serve. Physical therapist services lower the rate of disability and associated clinical cost by reducing the need for services of greater expense, greater risk, or both to the patient/client.¹ As such, APTA encourages insurers to consider the unintended consequences of policy decisions, including cost-sharing methods. Access the complete position paper.
The American Physical Therapy Association (APTA) represents more than 80,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com. Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.
¹Peterson LE, Goodman C, Karnes EK, Chen CJ, Schwartz JA. Assessment of the quality of cost analysis literature in physical therapy. Phys Ther. 2009;89(8):733-755