• News New Blog Banner

  • South Dakota Law Protects Patients From Excessively High Copays

    Last week, 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 Chapter.

    HB 1183 limits the amount a health insurer may charge a patient for an out-of-pocket copayment or coinsurance amount when he or she visits a physical therapist or occupational therapist. After the bill takes effect July 1, those copayment and coinsurance amounts cannot be higher than those charged when a patient visits a primary care physician or practitioner.

    Health insurers often categorize physical therapy as a "specialty" service, and typically require higher copays than primary care services—sometimes as high as $60 or more for a single visit. 

    "Legislators saw that this bill was all about patient access and affordability," said Ronald Van Dyke, PT, OCS, president of the South Dakota Chapter. "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."

    Read more about House Bill 1183 in this APTA press release.   

    Last year, Kentucky enacted a similar copay protection law.


    • Legislation restricting copays was much overdue. With the frequency patients attend our service, its not financially feasible for the majority of individuals to pay these rates. PT should NOT be viewed as a specialty by insurers, and copays should not exceed $20-25 per visit.

      Posted by Dave Ravnikar, PT, DPT, CSCS on 3/3/2012 9:55 AM

    • Hopefully more states can get similar legislation passed.

      Posted by Paul Weiss on 3/3/2012 3:08 PM

    • I love this!! Who's next?? Come on, New York!!

      Posted by Elizabeth Perlstein on 3/4/2012 11:46 AM

    • This needs to be adopted by all states. I hate to see a patient with a $60-70 copay where the adjusted amount of my treatment means the insurance company does not even pay a dime. The patient has to pay their premiums and copay for service and the insurance company paid nothing out.

      Posted by I. JOhn Orta, PT on 3/5/2012 9:57 AM

    • Pennsylvania has just launched a similar initiative. Would love to see this be a groundswell throughout the nation. Also curious as to how the insurance companies will strategize around this.

      Posted by Tom McNamee, PT on 4/3/2012 3:45 PM

    • Missouri currently has a "Fair Copay" Bill being considered among legislators. It's nice to see that precedents are being set for these laws in other states.

      Posted by Tony Friedrichs, DPT on 4/4/2012 11:17 AM

    • how bout the federal level?

      Posted by allison DPT on 4/5/2012 4:50 PM

    • We need to get this done in WA state. This is happening to our cardiac and pulmonary rehab referrals, too. Any PTs or OTs in WA who want to help me contact our legislature, please let me know. 425-261-3791, Gregory.Lawson@Providence.org

      Posted by Greg Lawson on 1/16/2013 11:29 PM

    Leave a comment
    Name *
    Email *