Hear how 3 APTA members use the association's position Physical Therapy Model Benefit Plan (MBP) Design to ensure consumer access to physical therapy services in 2 new podcasts in a series on MBP.
Steve Levine, PT, DPT, MSHA, who has nearly 20 years of experience as a consultant to physical therapy providers, local and national third-party payers, regulators, and case management agencies, explains how standardizing coverage guidelines can help address issues such as under- or overutilization of services. Levine calls MBP "an effective tool to use with third-party payers, regulators, and health policy makers to ensure that coverage design meets the needs of all of the stakeholders who will be affected by the coverage policies enacted by those who control the physical therapy coverage benefit."
Private practitioner Mick Bates, PT, uses MBP "to explain to my patients what 'good' coverage looks like when it comes to physical therapy so they can get the most of what they do have and negotiate for better coverage with their employers and carriers at renewal." Bates, who serves on the West Virginia Chapter's Reimbursement Committee, says the committee uses MBP as part of a tool kit for patients to file complaints with the insurance commissioner over coverage denials for medically necessary services. The committee also plans to use it in an upcoming meeting with the medical director and executive director of the Public Employees Insurance Association to negotiate for improved physical therapy coverage within the insurance plan for state employees.
Hear more from Levine and Bates in Physical Therapy Model Benefit Plan Design: From Position to Practice, Part I.
In Part II, Carole Galletta, PT, MPH, insurance relations chair for the Pennsylvania Chapter, describes how the chapter uses MBP to educate payers and support its efforts aimed at reducing out-of pocket payments and separating physical therapy benefit limits from other disciplines. She says, "…I think MBP provides us with an opportunity to clarify just what physical therapists do, to enlighten payers with our definition of medically necessary care, to identify how excessive cost sharing limits patient access to care, and to emphasize how physical therapy services can reduce disability and clinical costs."