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Syracuse (WSYR-TV) - In an effort to keep premiums down, many employers are choosing health insurance plans that have much higher co-pays. It’s a double edged sword for many people, especially those who need physical therapy.  In many cases, you’re being forced to choose between what you can afford and what your doctors prescribe. 

Sue Skibinski owns three physical therapy offices in Central New York. Over the past few years, co-pays for her patients have gotten out-of-control. She says that clients have to pay a wide range of different amounts from $30 to $60. Since most people require two or three visits a week, these prices quickly become unaffordable. “We’ve seen a significant number of patients who before would have required a month’s worth of physical therapy, now they’re telling me, look I can only afford to come three times, can you just do whatever you can do in 3 visits,” she said.

Sue says the high cost of physical therapy may be pushing people into unnecessary medications and surgery. One of her patients, Theresa Piering, needed repairs to meniscus rips on both of her knees. She says the treatment eventually just got too expensive. “I was coming in 3 times a week in the beginning, and then two.”

Part of the problem is that physical therapy is technically considered a specialty, so you’ve got to pay the more expensive “specialist” co-pay.  “You go to a cardiologist and the office visit fee is $400 and the insurance company is paying $360 of it, you have to pay a $40 co-pay, so you’ve paid 10% of the cost of service, I don’t think anyone thinks that’s unreasonable,” Skibinski said.

A physical therapy visit, however, is no where near that expensive. So Sue and some of her collogues around Central New York have made cards for patients with high co-pays to fill out, and they plan on bringing them to Albany in May. They want to be given a co-pay designation of their own, or at least be moved to the “primary care” category.

Chiropractors are running into this same problem. They too are technically classified as specialist so their co-pays are much higher. 

Because of how co-pay rules are written, there’s really nothing that can be done until there is a change in the law.  That’s why providers are petitioning local politicians.

The NYS Physical Therapy Association has put together a website with more information about how they’re trying to keep co-pays down: www.FairCoPays-BetterResults.com

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It Hurts When I…Sign for My Co-Pay

Wednesday, May 13, 2009

Lynne Enman tells how expensive co-pays mean she may have to stop treatment for chronic arthritis next week. Patrick VanBeveren, legislative director for the New York Physical Therapy Association, explains why physical therapists want New York State to designate them as primary care physicians as it pertains to co-pays and Alison Levy, health care journalist and advocate of integrated care at health-journalist.com, discusses the push for greater patient choice.

Click here for the full story and to read blog comments.

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Adding To The Pain

Reported by: Kristin Lowman
Email: kristinlowman@fox23news.com
Videographer: G. Finley
Editor: S. Sewell
Last Update: 5/12 10:01 pm
Adding to the Pain

Adding to the Pain

High co-pays are only adding to a patient’s pain. Turns out, some patients who are on the road to recovery hit a roadblock when trying to take physical therapy.

Now, physical therapists are working to make visits less expensive to help patients heal.

You head to physical therapy to lessen your pain to recover. But it turns out, the pain is getting worse for some patients, because it is hurting to pay their co-pay.

Take Samantha Tillman of North Chatham, paying $40, others paying $50 each time they walk into a PT door. Thats because in New York, some insurance companies consider physical therapy a specialty visit. That means a higher co-pay. Tillman says, “I’ve cut down to 2 times a week instead of 3 times a week like a doctor wanted me to.”

Now, physical therapists are fighting to get put on the primary physicians list. That would lower the co-pay and get people to their treatments.

Doreen Frank, a physical therapist at Columbia Physical Therapy says, “we’ve found they will cancel their appointments or they aren’t initiating going to treatments leading to more complications because people think they can do it on their own.”

With no shows, or canceled appointments recovery takes longer, or doesn’t happen at all. Therapists hoping what they can do today, can lessen the burden on their patients. They say their physical pain is already enough.

The New York Physical Therapy Association is lobbying the State Legislature to support a bill that is currently in both the Senate and Assembly.

In the Senate its Bill S.4321 and in the Assembly the bill number is A.8171.

WATCH THE VIDEO HERE

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PTs lobby for co-pay change

May 12, 2009 at 12:31 pm by Casey Seiler

The trade group representing New York’s physical therapists are at the Capitol today to address an issue that’s causing them a great pain in a part of their collective anatomy: so-called “specialty” co-pay fees that, they argue, presents patients with a financial disincentive to receive therapy and places these professionals at a disadvantage in terms of payment. Their release:

The New York Physical Therapy Association (NYPTA) [on Tuesday] will bring hundreds of members, advocates and patients to Albany to meet with state legislators in an effort to end the unfair practice of so-called “specialty” co-pays, which are costing patients in dollars and foregone treatment and physical therapists in lost patients and jobs, leaving New York State with a more costly and less effective health care system.

“NYPTA members and advocates are heading to Albany during difficult economic times but these are especially hard times for the physical therapy profession and our patients as a result of the managed care environment in which we practice,” said Jim Dunleavy, President of NYPTA.  “Managed care companies continue to restrict access to physical therapy services by imposing ‘specialty’ co-payments of $40 or more per visit, when the insurance benefit that the patient pays for is the same or only a few dollars above that amount.”

Managed care health insurers have designated physical therapists as specialists for co-payment purposes, allowing health plans to charge patients more per visit while maintaining reimbursement levels to physical therapists, thus shifting more of the cost burden onto the backs of consumers.

“These specialty co-payments add up for New Yorkers, since physical therapy frequently requires multiple visits over an extended period of time as the practice of physical therapy works in conjunction with the healing process,” said Dunleavy. “Health Plans call these specialty co-pays, we call them unfair.”

Dunleavy continued: “We know from firsthand experience that these co-payments prevent New Yorkers from receiving medically necessary care as many working families cannot afford to pay these high co-payments, leaving them no choice but to forego treatment altogether. Furthermore, New York physical therapists receive one of the lowest reimbursement rates in the nation despite the high costs of doing business in New York.”

As a result, NYPTA is asking members of the State Legislature to support S.4321 sponsored by Senator Breslin and A.8171 sponsored by Assemblyman Cahill to end the imposition of additional co-pays on New Yorkers for physical therapy services on the basis of provider or setting.

“Our message to the Legislature is simple,” said Dunleavy, “We hope each Senator and Assembly Member will support the hundreds of thousands of New Yorkers — their constituents — who need or are in physical therapy, who work in physical therapy, or have family members in physical therapy and please co-sponsor and vote for S.4321/A.8171 because fair co-pays do equal better results.”