There are growing national concerns regarding the increasing financial burden of out-of-pocket expense for the health care consumer, especially as it relates to physical therapy services. Under certain health plans, copayments for physical therapy services, some as high as $60 per visit, exceed the reimbursement paid by the plan to the provider of care. In addition, in many states and health insurance contracts, the physical therapist (PT) is classified under the specialist designation, which increases the financial burden to the patient by imposing higher copayments and thus restricts access to physical therapy services. High copayments for physical therapy have recently been cited as a reason that some consumers opt to reduce their frequency of care or forgo medically necessary care—running the risk of worsening the underlying condition and/or risking reinjury, thus potentially negatively impacting patient care outcomes.
APTA supports state legislation that provides for fair physical therapy copays and prevents cost-shifting to the patient as a result of categorizing physical therapists under the specialist designation. Building on the successful legislative effort earlier this year by the Kentucky Chapter to enact fair PT copays legislation in that state, APTA's Government Affairs and Payment Advocacy Unit has begun developing resources for chapters to advocate on this issue at the state level. A number of state chapters are currently coordinating with APTA State Government Affairs on possible 2012 state legislation. Be sure to check out the new resource Web page.