South Dakota Law Limits Physical Therapy Copays

Download in Adobe PDF

ALEXANDRIA, VA, February 27, 2012 — Thursday, South Dakota became the latest state to improve consumer protections from excessively high physical therapy copays when Gov Dennis Daugaard signed House Bill 1183, legislation promoted by the South Dakota Physical Therapy Association (SDPTA). This means less out-of-pocket expense for patients.

HB 1183 limits the amount a health insurer may charge a patient for an out-of-pocket copayment or coinsurance amount when they visit a physical therapist or occupational therapist. After the bill takes effect on July 1, those copayment and coinsurance amounts cannot be higher than those charged when a patient visits a primary care physician or practitioner. State Representative Mark Kirkeby (R) and State Senator Tom Hansen (R) were primary sponsors of the bill.

"Legislators saw that this bill was all about patient access and affordability," said Ronald Van Dyke, PT, OCS, president of SDPTA. "They wanted to make sure the people of South Dakota could access the physical therapy and occupational therapy care they need at a fair cost."

Health insurers often categorize physical therapy as a "specialty" service, and typically require higher co-pays than primary care services - sometimes as high as $60 or more for a single visit. Because physical therapy often requires multiple visits over an extended period of time, many patients find themselves paying hundreds of dollars per month in out-of-pocket expenses to receive the care they need.

"The idea behind HB 1183 is that through reduction of financial barriers to care patients will be better able to access the care they need and focus on getting better," said Van Dyke. "We believe it will also save healthcare dollars in the long run by preventing unnecessary delays in care that might allow a patient's problem to worsen, requiring higher-cost services like surgery and prescription medication."

"This couldn't have happened without the efforts of SDPTA members and their patients," said Phil Moe, PT, legislative chair for SDPTA. "South Dakota has always been a great 'grassroots' state, and that has once again proven to be true in this case. We asked for member support and received more than we could have hoped for."

The South Dakota Physical Therapy Association represents nearly 400 members statewide.

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 how to find a physical therapist in your area at Consumers are encouraged to follow us on Twitter (@moveforwardpt) and Facebook.