WIXT-9, The Real Deal On High Physical Therapy Copays

The following news segment recently aired on WIXT-9 and helps shed some light on the issue of high physical therapy copays in New York and the impact they are having on patient care.



Christine Casciano: In an effort to keep premiums down, many employers are choosing health insurance plans that have much higher copays.

Dan Cummings: It is a double edged sword for many people, especially those who need physical therapy, because in many cases, they are being forced to choose between what (they) can afford and what (their) doctor prescribes.

Christine Casciano: And Consumer Investigator Jennifer Lewke has the Real Deal now on how physical therapists say that it is only hurting everyone involved.

Jennifer Lewke: Sue Skabinski owns 3 physical therapy offices in Central New York. Over the past few years, copays for her patients have gotten out of control.

Sue Skibinski: Thirty, forty, fifty and in some cases sixty dollars [copays] depending on the plan.

Jennifer Lewke: And keep in mind, most people require two or three visits per week. Who can afford that?

Sue Skibinski: We have seen a significant number of patients who, before, would require a month's worth of PT. Now they are telling me, "Look, I can only afford to come in three times. Can you just do whatever you can do in 3 visits?"

Jennifer Lewke: Which Sue says may be pushing people into unnecessary medications and surgery. One of her patients, Theresa Piering, is beyond frustrated.

Theresa Piering: ...fifty dollar copay, so I had to pay the full shot. I had both knees (meniscus rips) repaired.

Jennifer Lewke: Eventually it just got too expensive.

Theresa Piering: I was coming in (at the beginning) three times, then it went down to two...

Jennifer Lewke: Part of the problem is that physical therapy is technically considered a specialty, so you've got to pay the more expensive "specialist" copay.

Sue Skibinksi: If you go to a cardiologist, and the office visit fee is $400...the insurance company is paying $360 of it, and you have to pay a $40 copay, you have spent 10%. You have paid 10% of the cost of service. I don't think that anybody thinks that is unreasonable.

Jennifer Lewke: But a PT visit is no where near that amount. Sue and some of her colleagues around Central New York have these cards for patients with high copays to fill out. They plan on bringing them to Albany in May. They want to be given a copay designation of their own or at least be moved to primary care. Most everyone here at Westside Physical Therapy agrees that a change is needed.

Theresa Pierling: It's become ridiculous, you know? It's like, "Why even have insurance?"

Jennifer Lewke: The word "co"-pay is a bit misleading too. In order to be in-network, physical therapists have to agree to accept a certain amount, per visit, from an insurer. Sue has an agreement with MVP, for example, that she'll accept $42 per visit. Most of her MVP patients are paying a $40 copay. So, the insurer is really only paying $2. Makes you wonder if it is even worth the stamp and paperwork to bill the insurance company. Of course, they have to but you get the ridiculousness of all of this. That is the real deal...

Dan Cummings: Now because of the how the copay rules are written, there is really nothing that can be done about this until there is a change in the law. That's why those providers are petitioning the local politicians.