Does your insurance plan have a high copay for physical therapy services?

Many people have discovered, much to their surprise, that their insurance copay for physical therapy services is significantly higher than the copay for a visit to their primary care physician.  Most health insurance plans designate physical therapist services in the “specialist” category which enables them to charge a higher copay for these services.  It is not uncommon for some insurance carriers to charge $40 or $50  copays for services rendered by a physical therapist. 

An episode of physical therapy care often requires multiple sessions lasting weeks to months depending on the condition being treated in order to achieve maximum benefit.  With physical therapy classified in the specialist category, the patient is responsible for a large proportion of the cost of treatment, despite the fact that their policy indicates coverage for physical therapy services.  Conversely, seeking the consultation of a medical specialist such as a neurologist or orthopedist usually only requires one visit.  Therefor the burden of cost to the patient is less and the insurance company pays a much larger percentage of the expense. 

High copayments have become a barrier to physical therapy care for many individuals.  The New York Physical Therapy Association has been working diligently on this issue to make our legislators aware of the situation.  For more information on the high copay issue in New York State and how you can voice your concerns to your local legislators, visit www.stophighcopays.com and www.nypta.org.

Andrew J. Opett, PT, DPT, OCS