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Journey of a DPT Student

Physical Therapy Co-Pays

Published January 13, 2014 4:41 PM by Lauren Rosso

You have to love insurance coverage. When January 1 came around, a number of our patients learned the unfortunate news that their co-pays had jumped anywhere from $10-$50. (The increase from $0 to $50 was an isolated event; however I'd estimate the average rise being around $15). This was a surprise for the majority of our patients, and the most regrettable aspect is the effect the increase in co-payments has had on their plans of care.

On patient particularly stands out. Her start of care was in November following a repeat rotator cuff repair and SAD. She's been through the wringer. She works as part of the dietary team in a local hospital and is responsible for delivering meals to patients throughout the day. Her original injury, in June, occurred at work while she was pushing one of those massive carts around. She's been out of work since that time, collecting only 60% pay.

We were finally cleared to begin some more rigorous return-to-work activities at the end of December and started to make some major progress with her ability to manage occupational demands. Then she came in on January 2 to learn that her co-pay had increased to $40. Realizing that she and her family have had a hard enough time getting by on 60% pay, I knew there was no way she'd be able to continue even twice per week. We decreased the frequency to once per week, and I just hope it's enough to get her to the point she needs to reach when she returns to work at the end of this month.

To find a positive in this situation, now more than ever we as physical therapists need to provide the most efficient, evidence-based care. It's what we should be doing all the time, but the consequences are becoming greater and greater. I imagine these situations are not going to get better, and we need to adapt with the current climate in order to maintain our significance.

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In NH, we are working with state legislators to introduce a bill that would limit the co-pay to PT to be no more than the co-pay for visit to primary care physician.  

Laurie February 7, 2014 12:10 PM
Claremont NH

When will we as health care professionals wake up? The only ones making out on all of this are the insurance companies. I bet that the patient's co-pay went up but her coverage didn't change or offer more benefits. She isn't getting more but sure is paying more which creates the inability for the patient to afford care, which in turn saves the insurance company money. Care that they would have been able to recieve last year. Health care organizations (AMA, APTA...) have to step up and let the government and insurance companies know that we are all are tired of their ways and profit margins. It is well apparent that the government can not run a profitable business and I haven't heard of any insurance carriers closing ther doors.

paul, phys. therapist February 7, 2014 12:00 PM
daytona beach FL

Even with these increasing co-pays, it's still important that patients return at least weekly for supervised treatment. No matter what home exercise programs we teach our patients, we know patients either don't do the exercises, or usually do them poorly... and that just prolongs their recovery. We have to offer something different in the clinic that they can't do at home so they see value in attending. Co-pays are expensive, but we should tactfully ask patients, "what's more valuable than good health"

John February 7, 2014 11:39 AM
Parkville MD

I am surprised to see the patient had a co-pay since the injury was work related.  Perhaps WC has denied the claim?  However, I do agree that co-pays have skyrocketed this year.  I have already had two patients say that they couldn't afford the $60 per visit co-pay required by their insurance.  Contracts with insurance companies do not allow us to "work with the patient" and provide treatment at a lower cost.  Where will it end?

Debbie, PT Assistant January 21, 2014 4:14 PM
Naples FL

This story, in my opinion, convinces me that we need to decouple from insurance companies in this country, so people can keep their money and pay us directly for their care. How many times are we going to sit here and say "we just need to be more efficient" while our patient's premiums go up, their co-pays go up, and their coverage goes down. How much longer?

James, Physical Therapist January 20, 2014 12:42 PM
New York NY

This story brings home Lisa's question in her post last week, "Which is more important, the diagnosis or the treatment?" Situations like this make it VERY clear that we have to get both right otherwise we're wasting patients' time and money. Every interaction has to count and progress the patient towards their desired outcome.

Dean Metz January 13, 2014 5:00 PM

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