Take Action: Help Bring An End To High Physical Therapy Copays

Imagine you are a single mother of 4 who goes to the store to purchase milk for you and your family. The last time you went shopping, a gallon of milk was $2.39. Today you walk into the store to discover that there is a new pricing plan in place. Strangely, if you buy only one gallon of milk, the store is only going to charge you $2.39, but if you purchase more than one gallon of milk, the price is going to double to $4.78 per gallon. How could this be? How would that be equitable? Isn't the store just making that much more money at your expense, and on a product they KNOW that you need for the health of your family?

Unfortunately, for subscribers of insurance plans in New York State (including Blue Cross Blue Shield, Pomco, and others) this is what is happening in regards to their physical therapy coverage. In an effort to cut costs, many of New York State's managed care companies have decided that because most patients have to attend physical therapy two to three times weekly, they are going to charge the patients more for services rendered at physical therapy offices than they will at other medical offices. Many insurance plans now charge their subscribers nearly 110% more for copays to physical therapy clinics than to their general practitioners. It is not uncommon for a patient to go to visit their physician's office for blood work, a diagnostic workup and evaluation for $20 and then be charged $50 for their copay when they attend their first physical therapy visit.

Mary Lou Corcoran Physical and Aquatic Therapy, in support of legislation endorsed by the New York American Physical Therapy Association (NYAPTA), is asking for your help in ending this unfair and inequitable practice of deferring cost from the insurance companies to the patient when it comes to receiving the care that they so desperately need. The NYAPTA President states:

"Physical therapy provides cost effective care that gets people back to work sooner, reduces pain and suffering and gives people the opportunity to live happy and productive lives by maximizing their potential for movement. Insurance companies have decided to place a barrier between physical therapy and their patients for purely financial reasons. Patients who need physical therapy are having a hard time keeping up with these high co-pays which are keeping them from finishing their care and reaching their goals. Managed care health insurers have designated physical therapists as specialists for co-payment purposes, allowing health plans to charge patients more per visit while maintaining reimbursement levels to physical therapists, thus shifting more of the cost burden onto the backs of consumers. These specialty co-payments add up for New Yorkers, since physical therapy frequently requires multiple visits over an extended period of time as the practice of physical therapy works in conjunction with the healing process."

As a worst-case scenario, the situation has gotten so bad that physical therapy clinics state-wide are actually being forced to accept co-pays from patients that are greater than the negotiated rate with that insurance company. The physical therapy clinics are left powerless, placing themselves at risk of being charged with insurance fraud if they accept co-pays that are less than their contractually obligated amount. Even worse, because of the resultant lack of affordability, the patient attends therapy less frequently per week than recommended by the therapist/physician and minimizing the positive impact that therapy could have on the patient's pain and difficulties with daily activities.

With your help, New Yorkers can work to take back control of their insurance plans and cease this unfair business practice of managed care companies. We implore all New York residents to take action. The NYAPTA encourages residents to:

1. Call, email, and write your state legislators and tell them you want LOWER physical therapy co-pays; ask for fair-co-pays and ask them to support of two bills in the State Legislature, S.4321 (Breslin) / A.8171 (Cahill), which will prevent managed care companies from requiring patients to pay these excessively high co-payments for PT.
2. Sign the NYAPTA's Online Petition here
3. Tell your employer and health plan you oppose these high co-pays for your physical therapy.
4. Write a letter to your local newspaper.
5. Call your local media and invite them to tour your practice and discuss these high co-pays.
6. Pass this information along to your coworkers, friends, and family.

Albany needs to act. They need to act now. Every day, week and month that goes by without legislation is another opportunity lost for a patient who desperately wants to get better, can't return to work or is in excruciating pain but can't get better fast enough; a direct result the insurance industries compulsive need to redirect the cost burden to the patient to maximize their own profits.