Specialist Co-pays for PT

[Guest guest]

Since the rules for Medicare changed and they began creating private

insurance for Medicare patients, private practice physical therapists have

been lumped into the specialist co-pays which typically are $35 to $50 with

most being $35. Our Medicare patients are typically on fixed incomes and

can not afford to pay $35 three times a week for four weeks which equals

$420 a month for therapy. Many of them need therapy for even longer periods

then one month. So more and more we see Medicare patients come in for an

initial visit and just not return or they come in and ask for a home

exercise program which they may or may not follow or do properly. I have

spoken with numerous insurance companies about the concern over the copays,

but no one seems to be listening. Everyone I speak to agrees that causes an

undue hardship and they swear that their sales people go over the limits of

coverage with the client, however I bet no one says to them that if you need

therapy that will be a specialist treatment and you will pay the higher

copay for it.

According to PT in Motion, Kentucky has resolved this problem.

* Managed care companies in Kentucky often impose " specialty " copays

of $50 to as high as $75 per physical therapy or occupational therapy visit.

Senate Bill 112, sponsored by State Sen Tom Buford ® and advocated for by

the Kentucky Chapter, limits a copayment or coinsurance amount for a

physical therapist or occupational therapist visit to no greater than the

copayment or coinsurance amount charged to a patient for a physician or an

osteopath for an office visit. SB 112 also requires insurers to clearly

state the availability of therapies under their plans, and all related

limitations.

Is this something that should be universal across all states and why doesn't

Medicare set a limit for Medicare advantage products? Does anyone have

thoughts on how we should proceed with resolving this problem or is this

something we just need to take up with our own state legislators?

Thanks for any thoughts.

Becky A. Sewell, MRC, CRC

Rehab Net of AR/ArPTA

P.O. Box 202

Conway, AR 72033

ph/fax