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  • APTA to Assist Chapters in Strategies to Reduce Patient Co-pays

    Recognizing that patient co-pays for physical therapy services under certain health insurance plans exceed the insurer's payment to the provider, APTA will help chapters to pursue policy and legislative options to reduce these excessive co-pays. During its discussion of the charge Reducing the Burden of Current Copayment Systems, the House of Delegates acknowledged recent efforts by the Kentucky, Colorado, and New York chapters, and assessed the probability of several options that chapters could pursue, such as designating physical therapists as primary care providers.
    [RC 16-11] 

    (Related: "House Amends Positions on Student Supervision and Disclosure of Benefits")


    • As a practicing PT and private practice owner I am very interested in this issue. To have us designated as specialists, which requires the insured to pay the higher copay, and yet we get paid by the insurance companies at a much less rate than specialists such as dermatologists, otolaryngologists, etc. is significantly reducing the ability of the patient to see the PT regularly and therefore reducing both outcome to the patient and revenue to the practice. And now with Medicare and Aetna cascading reimbursements it will become even more difficult to give quality care. Certainly, designating PT's as PCP would be a good first step.

      Posted by Linda Johnston, PT on 6/17/2011 6:51 PM

    • I am very interested in this. I feel that many insurance plans abuse the purpose of a co-pay. We have many patients who have a co-pay that exceeds the insurance pay portion. Some have 40 dollar plus co-pays, which is really too much to ask anyone to pay, considering PT is not a one time visit thing. When you consider that some of these plans only pay 55 per visit, it is ludicrious to call the patients portion a co-pay. I also see that plans have high deductibles and then have low visit limits, which again is another strategy to limit payments. All in all, I strongly feel that an insurance company should not be allowed to pay less than what it actually costs to provide the service.

      Posted by Dano Napoli on 6/20/2011 9:48 AM

    • I am in private practice 10 years now and our profession is taking quite a hit from these insurance companies. How can we provide quality care and get a patient better when the copays are outstanding and the visits are severely limited and scrutinized. This insurance industry needs some restrictions on copay and premium amounts charged. They are reaping the rewards and the hard working PT's are being ripped off. Somebody please help already.

      Posted by William S. Macri on 6/20/2011 4:33 PM

    • Something that I would like to see happen is legislation that places the burden of collecting the deductible on the actual insurer instead of the provider. Insurance companies are mandated to pay us within a reasonable time frame once the bill has been submitted. Once the insurance company denies payment because the patient has not met their deductible we are then forced to go through multiple billing cycles to get payment from the patient that can often end up in collections, small claims court or not receiving payment at all or at a reduced rate. I would like to see, at the very least, that the insurer is to pay for the service up-front as part of their agreement to provide insurance and then go after their member to recoup deductibles rather than pitting the provider against the patient for collection of monies owed. I think the age of high deductibles is going to crush most small private practices as well as have a negative impact patient care. If an insurer agrees to charge a certain premium to a member, the law should make the insurer liable to collect money from their member. For example: If someone slips and falls at your business and injures themselves and then sues you for medical expenses your insurance company pays the claim and then sends you a bill for the deductible. They don’t go to claimant and say “we will pay you minus our client’s deductible.” How and why is personal health insurance any different? I think this is another example of our lousy politicians on Capitol Hill being bought-off by the big insurance company lobbyists and our lobbyists either not recognizing this ahead of time and/or not having any ability to do anything about it. It starts with voting every politician who has been in office for way too long OUT!!!! They continue to let this happen.

      Posted by Darin McCarthy on 6/24/2011 4:58 PM

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