Insurance Plan Design

Physical therapy is a health care profession whose primary purpose is the promotion of optimal health and function. As such, the profession has a responsibility to ensure access to physical therapy services so that health care consumers receive the services they need to address activity limitations and participation restrictions. In recent years, insurance benefit plan design changes that inappropriately restrict access to medically necessary services have been noted. These changes include escalation of out-of-pocket payment requirements, combining physical therapy benefits with other professional disciplines such as chiropractic and occupational therapy, requiring multiple copayments for the same patient on the same date of service, and denial of services based on arbitrary visit limits and utilization management guidelines.

The Physical Therapy Model Benefit Plan Design (MBP) was developed to inform insurers, employers, individual insurance plan subscribers, and public policymakers about these issues and provide a template for the appropriate design of insurance benefit plans with regard to physical therapy services. The position was adopted by the APTA Board of Directors in December, 2011.

The MBP describes the role and value of physical therapists and physical therapy services and sets forth principles to guide development of physical therapy benefits. It also provides definitions and references to support the position. APTA members and components should use this position when advocating for access to physical therapy services under insurance benefit plans.

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