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THE ISSUE

Health insurers are now requiring patients to pay
the higher "specialist" copay for physical therapy care, putting physical therapy care out of the financial reach of many patients. This practice costs patients in dollars and foregone treatment, physical therapists in lost patients and job; and all New Yorkers with a more costly and less effective health care system.

End Unfair Practice of "Specialty Copays"

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.

Health Plans call these specialty copays, we call them unfair.

If the insurance company was required to pay 80% of the reimbursement, then the financial burden on physical therapy patients would be alleviated.

One Patients Story:

This is my own story.  I am a student (D’Youville College, Buffalo) and PT member of APTA and the New York Chapter.

I had severe pain in my left arm in 2009.  This pain gradually increased to the extent that it became painful to move my arm even for putting on a winter coat, or putting the car seatbelt on.  I was ready to take any medicine since I had been having the pain for some months…but it became unbearable by December 4th of 2009 and the emergency visit happened.

After pain medication (I took only one tablet as I don’t like the side effects and I had final exams that week), and Aleve, which worked like a wonder, I had to visit the PT’s office for a few months.  Every visit had the specialists’ copay of $30.  My husband is the only bread winner of the family and me being a student, I have student loans running above $100,000, and we have to pay for the day care of our two daughters, the copay was a bother.  After an MRI, bursitis was diagnosed.  I know it takes a long time for the bursitis to heal so after taking a steroid shot at the subdeltoid/subacromial bursa and another few PT sessions I stopped going to PT.  I am not completely healed but I cannot afford to pay the high copay twice a week.

I urge you to do everything possible to convince the lawmakers/insurance underwriters and whoever is concerned to revise the copay for physical therapy office visits.  I am a student in physical therapy and also know how important it is for someone to have PT visits to return back to their functional level and that in the absence of the PT office visit patients do not usually do the exercises.  Therefore, it would be great if the copays to the PT offices could be reduced to the same rate as copays applicable for primary physician’s office visit.  This would encourage people to visit the PT office and get the required care without worrying about the fees.

Thanks,
Sumedha