Comments

• That is great to limit a pt's co-pay however is this at the expense of the provider providing care on a plan that is capitated at a certain dollar amount; this would not only cut reimbursement to the provider from the capitated monies, but also from the co-pay aspect. For example, if a patient underwent RTC surgery (thus needing 8 weeks of PT), but the capitated plan pays for about 6 sessions, how can a company stay in business (pay professional staff, pay admin staff, keep lights on), now that the co-pay is going down? Please check fine lines on insurance contracts. Patients know they need rehab after surgery and generally know their co-pay for each session and save for this, however generally don't realize how their plan reimburses the provider. Just something to think about.

  Posted by Dianna Bishop on 3/25/2013 7:38 AM

• Dianna...I am afraid you are mistaken. The co-pay is just the amount the patient is responsible when they walk in your clinic. The rest of the bill is still reimbursable through the third party payer. Therefore, the provider will get the same amount of money but will have less needed from the patient. I am sorry you did not understand but this is good for both the patient (as they will have to pay less to complete their therapy) and the provider (there will be more compliance with the program and more patients will go to therapy and complete therapy.

  Posted by Steve Forbush on 3/31/2013 6:52 PM

• Dianna, I think you are confused. The co-pay is the per-visit amount the patient is responsible for when they walk in the door. The insurer will then usually reimburse a percentage of the remainder. This is not related to the issue of capitation, which is an entirely different matter.

  Posted by Robert Jordan -> @KU\E on 4/15/2013 3:11 PM