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  • New Resources Available to Assist State Advocacy Efforts on Fair PT Copays

    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.  


    • What is being done about some of the insurance plans that vary co-pays between hospital outpatient PT and private practice Pt? I have had several patients that if they come to my clinic they have a $30 co-pay but if they go to the hospital they have no co-pay. How is that possible and what is being done abou that?

      Posted by Jim Carlsen on 12/9/2011 4:55 PM

    • Some copays as high as $60/visit exceed the reimbursement paid by the plan? $40 is a break even in NC. The state health care plan administered by BCBS of NC has its members pay 62% of their fee. I'm not sure how much help we will get from states if this is their plan of choice.

      Posted by MaryEllen Axner on 12/11/2011 11:38 AM

    • I'm all for this and am willing to help my state association with the efforts. The next step would certainly be to have equal reimbursement. Not only are hospitals able to reap the benefits of no copay, but other larger national corporations have the ability to collect a higher reimbursement based on another state. I would just like to be on a level playing field.

      Posted by Linda Johnston, PT on 12/11/2011 2:00 PM

    • I would just qualify the language of this post a bit since physical therapists, in general, see themselves as specialists. However, the Co-Payment problem is largely due to Physical Therapists being categorized as MEDICAL SUB-specialists, such as orthopedic surgeons and neurosurgeons. To quote John Barnes, APTA CEO... "Physical therapy is NOT a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are untrained and unqualified to provide." http://bit.ly/vidWAI Therefore, CoPayment classification of physical therapists as a medical subspecialty robs patients of access to a necessary preventative health service and, ultimately, raises health care costs to consumers and their employers. Thank you, Tim Richardson, PT

      Posted by Charles Richardson -> =GR^EM on 12/21/2011 1:36 PM

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