Too often, insurance requires copays that effectively reduce access.
Patients typically see a physical therapist multiple times during an episode of care, but excessive copays can make that difficult—maybe even impossible for some. 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. High copayments for physical therapy are one reason that some consumers opt to reduce their frequency of treatment or forgo medically necessary care.
Why It Matters
Currently, in many health insurance contracts, the PT is classified as a specialist, which increases the financial burden to the patient. In states or in insurance companies where this designation is used, the specialist classification is often accompanied by higher copayments for the consumer.
This specialist designation—and related higher cost to the consumer—runs counter to typical PT care. Most other health care specialists are seen in consultation at significantly less frequent intervals than what's typically required in contemporary physical therapy care. The result: your patients can't afford to see you as frequently as clinically indicated. Or they can't afford to see you at all.
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.
Additional Fair Physical Therapy Copays Advocacy Content
Jul 26, 2021 / Roundup
From better insurer responsiveness to direct access improvements, to breakthroughs on PT use of imaging, lots of state-level achievements.
Feb 23, 2021 / Roundup
The fight to improve direct access continues, use of the licensure compact grows, and telehealth is being discussed just about everywhere.