High Copay Bill
Talking Points
NYPTA Lobby Day – April 25, 2017
High Copays - Talking Points
-**We are working to introduce a revised copay bill within the legislature and hope to have bill numbers ASAP. **
-Disproportionately high insurance copayments continue to limit access to necessary PT services
-New language will remove the previously proposed 20% copayment limitation in favor of a strategy that would be more easily implemented by insurers. Our goal is to remove the specialist designation and align the PT copayment with that of primary care services.
-Health insurance imposed co-pays are currently unlimited, often equal to or exceedingthe actual cost of the treatment, and have put necessary physician-prescribed treatment out of the reach of many New Yorkers already paying ever-increasing insurance premiums.
-Health plans have shifted the vast majority of the cost of physical therapy services by imposing high “specialist” copayments on consumers. This category is generally reserved for higher-cost services such as care by neurologists, cardiologists, and neurosurgeons.
-This is particularly misleading to the patient who expects that the physical therapist is being reimbursed by the insurance company in addition to their copayment.
-The real problem is high co-pays are limiting access to necessary physical therapy care, resulting in unnecessary surgery, epidural injections and expensive imaging studies.
-A 2012 study demonstrated that earlier physical therapy leads to better outcomes. In 32,070 patients who were newly consulting a primary care physician for low back pain found that those who were referred to a physical therapist early (within 14 days of consultation) showed a reduced risk of subsequent health care utilization including decreased utilization of advanced imaging, surgery, additional physician visits, injections and opioid medications and lower overall health care costs than did those patients with delayed treatment by a physical therapist.[1] According to the study, total health care costs for patients receiving early care from a physical therapist were on average $2,736.23 lower per episode of care.
-New studies are proving that physical therapy is equally or more effective than surgery for managing certain conditions including knee pain and back pain.
-An NYPTA poll conducted in 2010, found that 71% of New Yorkers would be more likely to receive all necessary physical therapy care if insurance co-pays were lower. As a result, many patients forego treatment as they cannot afford it. They may then need higher more expensive levels of care for something that could have been managed conservatively for a fraction of the cost. In some situations such as back surgeries, joint replacements or other orthopedic, patients can’t afford the physical therapy co-pays after their procedures and choose to forego care, which then delays recovery or results in failure to benefit from the surgical intervention.
Fritz et. al. Primary Care Referral of Patients with Low Back Pain to Physical Therapy: Impact on Future Health Care Utilization and CostsSpine Dec. 1, 2012, 37(25), 2114-21.