Fair Physical Therapy Copays

There are growing national concerns regarding the increasing financial burden and of out-of-pocket expense for the health care consumer. More specifically, because patients typically see a physical therapist multiple times during an episode of care, the financial burden of copayments may be a deterrent to accessing care. Under certain health plans, copayments for physical therapy services, some exceeding $60 per visit, also can exceed the reimbursement paid by the plan to the provider of care. This cost shift has imposed an unnecessary financial burden on consumers, and 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.

Currently, in many health insurance contracts, the physical therapist is classified under the specialist designation, which from a fiscal perspective increases the financial burden to the patient. In states or in insurance companies where this designation is utilized, the specialist classification is often accompanied by higher copayments for the consumer. Most other health care specialists are seen in consultation at significantly less frequent intervals than that required in contemporary physical therapy care. Therefore, resulting in the patient paying higher copays for the specialist visit, as well as, burdened with paying copays for each physical therapy visit.

APTA supports state legislation by our chapters that provides for fair physical therapy copays and prevents cost-shifting to the patient by categorizing physical therapists under the specialist designation.

Legislative Resources

State Efforts and Examples

Articles

ADVERTISEMENT