wnyc.org / 93.9fm / am 820

Copays for PT are so high that at times they represent the entire bill. Insurance companies are portraying that they provide a PT benefit but in the end the patient's co-pay represents the entire amount. Is this fraud?

I am a physical therapist who had to close my practice due to such terribly low reimbursement it meant I was subsidizing insurance companies. When I first started they promised higher volume of referrals by not signing on others to the network. They have not kept that promise, they controlled and regulated PT with no government protection of existing law - receiving special treatment because they had more money for lobbying, increased the burden on PTs in contracts, never made fair increases in reimbursement for 25 years and then decreased patients rights and the idea that insurance was to help patients. This while they make a profit so large government borrows more from insurance companies than banks! For ALL of us needing or in healthcare, we need the entire system reorganized with justice to all!

I support the idea of having A PT as a primary care Physician for copayment issues. Physical therapist should be the profession of choice for any musclosckletal problems. Physical therapist well trained in dectecting and diferniate between muschelo-sckeletal pain form systemic orgin or muscle orgin therefore they will be able to reffered the patient to the right specialist. Working with PT profession as an alternative medicine can safe insurance companies a lot of money in return of preventing unnessary surgery.

I think the point is being missed here. Physical therapists do not expect to be considered an alternative to primary care physicians. However, due to the freqency of visits for PT, the co-payment tier should be the same as that of a "PCP" - especially since the physical therapist is not paid at the same rate as a specialist physician. Also note that in NY State, it is legal to directly visit a physical therapist for a musculoskeletal injury and receive 10 physical therapy visits within 30 days without a prescription from an MD.

There were many points brought up in this segment that need further clarification:

1) Changes in patient Co-payment do not affect that total amount fo money that a therapist recieves for their service. Lowering the PT co-pay to an office visit rate would not allow the therapist to receive primary care physician fees. It would only force insurance companies to pay the majority of the PT expenses instead of paying the 10% or 20% they pay now.

2) Changing the PT co-pay designation from specialist to primary would in no way change the PT's role in health care.

3) PT's in NO WAY want to replace primary care physicians. If you have flu like symptoms no one beleives a PT is the person to see. However if you sprain your ankle seeing a PT first would be the most cost effective and medically prudent course of action for a patient.

Lowering PT co-pays only helps the patinet to afford needed medical care. It forces the insurance company to actually pay for the services it claims to cover and it in no way allows PT's to make any more money or change their role in the health care system.

Further Clarification:
At one point in the segment, the legislative director from the New York State Physical Therapists Association said therapists are reimbursed only $45 for therapy visits. Members of that association say that may be misleading. At least one insurer in upstate New York reimburses at that rate. Most pay slightly more, between $55 and $65. Medicare, the government-sponsored program for seniors, not medicaid, reimbursements are higher. The highest reimbursements are for out of network care, according to NY Physical Therapist Association members consulted in preparing the segment.

I have 2 comments:
I am a physical therapist in Queens.
Comment #1 is to BL Producer from WNYC: Where did you get infromation that Medicaid pays highest - Medicaid can pay as low as $14 per PT visit or as high as $36. A lot of what is paid depends on the venue of treatment. For instance, hospitals, physician owned physical therapy practices and physcial therapist owned practices are often reimbursed differently - always with the physical therapist owned practice being paid the least.

Comment #2: Physical therapists are not trying to become Primary Care Physicians. However, if a patient goes to a specialist, they ususally go once for a consult. Since the MD is a specialist, the fee they get is higher than the primary care physican. When a patient goes to physcial therapy, they often need to go 2 to 3 times a week. The high co-pay then interferes with necessary treatment. Also the physcial therapist's reimbursement is not anywhere near that of a physcian specialist - so the insurance company is saving lots of money and the patient is discouraged from receiving care.

For LYNNE: I too have psoriatic arthritis but have cured it using holistic non-medical methods. See www.psoriasis-healing.com or contact me for more info.

Clarification on Reimbursement:
At one point in the segment, the legislative director from the New York State Physical Therapists Association said therapists are reimbursed only $45 for therapy visits. Members of that association say that may be misleading. At least one insurer in upstate New York reimbursed at that rate. Most pay slightly more, between $50 and $60. Medicaid reimbursements are the highest.

I’ve been buying 100% of my own insurance for over 9 years now. I’ve had 3 different health insurance companies during that period. Buying health insurance can be like buying a sub prime loan… You have to read every word in the contract so that you know exactly what you’re getting. If you don’t, you’ve signed a legal contract that will guarantee to have a whole bunch of unwanted surprises. I just can’t feel sorry for the caller that thought PT was for free…. Like anything your going to spend a lot of money on, buyer beware…

My 2year old son had a bat in his room, state law says he needed 5 rabies shots. Emergency room is the only place you can get it and my copay for emergency is $100. 5 visits - $500!!

It's very difficult to choose among plans when they are presented to you because all of the plan info is presented in different formats making it impossible to compare plans. In addition, sometimes after you sign up, what you got is NOT what was in the original paper.

There needs to be a common format presenting the information much like the box that is on credit card applications, which I believe was put into play by Charles Schumer, since consumers were TOTALLY confused by the info presented by cc companies.

Maybe the problem is with doctor's bill. If a 15 minute with a specialist can cost as high as $8000 for an in office session, how can I expect my co-HMO members and the insurance company struggling to survive to foot the bill for my pain?? If Wall Street should be told to control their salary shouldnt also doctors so that we as a nation wont have to bite the bill for an expensive healthcare system?

It sounds like this discussion is symptomatic of the deeper problem with healthcare.

We really need to re-think things from A-Z. It's very clear that the system does not work well for patients.

Take action about healthcare -- here are links for joining in some good efforts:
http://www.dailykos.com/storyonly/2009/5/11/94923/1551

http://www.dailykos.com/storyonly/2009/5/9/134213/4154

Hooray for Physical Therapists (and Occupational Therapists). My saviors.

And how is the time we're spending discussing all of this figured into societal calculations--government reform calculations--of what "health care reform" will cost?

Not strictly a copay point, but in general, physical therapy is often treated as the poor relation by insurance companies. When I severely injured my knee (multiple fractions, major dislocation, months laid up in a knee immobilizer, I found out that my insurance coverage only allowed for 60 days of PT per incident, period. The nature of my injury, the time for bones to heal, and to learn to walk again takes months and months by the laws of biology, yet for the insurer, whether one has tennis elbow, or is thrown off a horse and becomes a paraplegic, no more than 60 days of PT. Obviously, some insurers don't take the discipline seriously.

My apologies! I forgot to mention the pertinent factor in my previous post...my primary care physician also gave me some physical therapy exercises for my lower back pain and knee joints. She has referred me to a physical therapist in the past, but the expense prevented me from getting the proper treatment.

Currently my yoga and pilates classes at my local YMCA seem to be doing the trick at a fraction of the cost.

When my primary care doctor gave up her practice due to the politics of the insurance companies I switched to a Chiropractor/Acupuncturist for my chronic back pain. She is paid as a primary care physician by my health plan and I no longer have to take expensive prescription medication. The best part is that I am now relatively pain free and my general health is better due to the nutrition and exercise plan she recommended.

Physical therapists are great, should have more autonomy, and real insurance parity, but they are not equipped to be primary care providers. Primary care providers need to be able to prevent disease, screen for disease, and manage serious medical conditions like high blood pressure in order to provide an adequate medical home.

I miss co-pays! My company last year swtiched to a high-deductible plan, where I am required to pay the full amount to my doctors until I have spent thousands of dollars out of pocket. Only then are my visits covered to any degree. Please do a segment on the shift to this type of coverage, which I believe has a much higher impact on people holding off on seeking care.

I had a problem with my back years ago when I was unemployed and on COBRA. I did not realize that there were limits to the physical therapy. The therapists never checked with the HMO as to how much can be covered. As a result I got sent a bill. I wound up not paying it because I think they realized they made a mistake.

Its not HMO's fault regarding the coverage. They will cover anything you want, your employer just has to pay for it in their insurance costs.
A lot of employers view physical therapy as a scam.

Absolutely. I do have health insurance through the Freelancers Union, but my budget really only allows for a primary care physician at this point. I definitely need some mental therapy and psychiatrist appointments, but those will have to wait.

I am fortunate that my primary care physician was both able to do my pap smear and prescribe some Wellbutrin during my last general checkup. I automatically saved specialist copay for an OBGYN, and at least one psychiatrist session!

After reading this article from today's Bergen Record, perhaps this will help us learn where some of our copays go:

http://www.northjersey.com/news/aroundnj/NJ_hospital_CEOs_pay_tops_US_average.html

My co-pay horror story... $30 co-pay, 4 small children (one 4 mos.). If I have a check up and a child gets sick, thats $60 in one week; and there is always the follow up visit. I really do have to think twice if its worth it to take my child in, or if I can just treat them at home.

a name for this current economy

corressiion

correction plus recession/depressiion

I could not afford the co-pays for physical therapy for my frozen shoulder, especially after my doctor and the therapist to whom he referred me dropped out of my health care plan due to low reimbursements (a scandal in the NYC area).

I fixed the shoulder using Yoga DVDs. It took about six months. Maybe the therapy would have repaired the shoulder faster, and surely patients with chronic arthritis and other serious disorders cannot use Rodney Yee as their physical therapist. That I had to turn to self-help says alot about the system.