Executive Summary: It is unfair that physical therapy is considered a “specialty service” which requires patients to pay high out-of-pocket costs to receive treatment. Individuals access to physical therapy is limited because of these outrageous co-pays. Decreased use of therapy services has the potential to lead to higher medical costs for health insurance companies in the long run. A bill lowering co-pays to a price comparable to the cost required for a primary care visit can not only improve access, but save money in the long run as well.
Problem Statement: Co-pays for physical therapy services in New York state are very expensive, requiring patients to pay a great deal to receive therapy. For example, if a “specialist” co-pay was
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Contrary to a true “specialist” for example, a neurologist, which may require patients to visit them a few times each year; physical therapy often requires numerous treatment sessions. Health insurance companies believe categorizing physical therapy as a “specialty service” is positive because it’s lowering premiums and shifting more of the cost to the policyholders. However, the decreased access to physical therapy because of outrageous co-pays can result in high-cost services in the future such as; increased doctor’s visits, prescriptions, and surgical procedures. A prime example of this was when I opted for rotator cuff surgery. Since co-pays were extremely high, surgery was the best option financially. This resulted in greater costs for the health insurance company since the deductible was met. Increased costs included; prescriptions for pain control, doctor visits, surgical costs, and post-op therapy services. A bill that lowered co-pays for physical therapy services could result in avoiding unnecessary surgeries and would save health insurance companies a great deal of money in situations like the one mentioned above.
Recommendations: Physical therapy needs to be considered a primary care visit rather than a specialty service. Co-pays must be lowered to decrease the burden of out of pocket costs for patients receiving therapy services. Kentucky and South Dakota are two states