When it comes to payment for physical therapist services, neither APTA nor its state chapters can negotiate rates with payers. Due to antitrust laws, negotiating rates is solely the purview of the individual provider. What APTA and your state chapter can and do provide, however, are guidance, tools, resources, and information on aspects of the payment process. These include identifying practice costs, knowing what to look for in a contractual agreement, and advocating for the value of physical therapist services in improving the overall health of individuals served by physical therapists (PTs) and physical therapist assistants (PTAs).
Unlike federal programs such as Medicare and Medicaid, private insurance companies—for example, Cigna or Aetna—are not bound by laws or regulations that dictate how they establish rates. The company is considered a private entity that is entering into a contract with another private entity (the practice) and is free to negotiate the rate it sees fit. Keep in mind that issues with provider agreements are not always specific to payment rates. Some payers allow for fair and appropriate payment, but other clauses within the agreement may affect providers' bottom line, involving administrative processes, denial and appeal efforts, preauthorization, and claims adjudication.