Download Briefing Paper HB 2408 / SB 6266 Health Insurance Copays

Briefing Paper
HB 2408 / SB 6266
Health Insurance Copays Decreasing Patient Access to Physical Therapy Care
What is the problem?
 Insurance carriers commonly classify physical therapy as “specialty providers,” resulting in a copay
that is higher than the primary care copay.

Surveys reveal that patients are being charged a $40 to $80 copay per physical therapy and other
rehabilitation visits, which is significantly more than a primary care provider visit. Primary care copays
usually range from $0 to $30.
How does it impact patients?
 The exorbitant cost of multiple patient visits for rehabilitation services creates a barrier to conservative,
cost-effective care. Patients choose to discontinue or reduce the frequency of physical therapy care.
 An Associated Press survey (cited in the December 12, 2014 Seattle Times) reported that of 1,004
people with healthcare insurance, 30 percent had skipped medical care because of rising out-ofpocket costs.
 Early care saves money. Billions of dollars are spent to treat chronic pain in America each year, yet
some costs may be avoidable with early intervention of physical therapy services.
o A 2012 Spine journal study concluded the cost to treat patients receiving early physical therapy
was an average of $2,736.23 less than patients with delayed access to physical therapy care.
o At the Virginia Mason Spine Clinic, immediate access to physical therapy is the hallmark of the
program and results in the average patient recovering from back ailments after five (5) visits.
This result is one half (1/2) of the national average for visits (ten (10) visits).
o Research that supports preventive care or early access to care is more beneficial in terms of
higher patient satisfaction, desired outcomes and reducing costs.

When disorders require patients to receive same-day services from multiple rehabilitation providers,
such as a physical therapist, occupational therapist and speech language pathologist, daily copays can
exceed $200.
What is the cost?
 Decreasing member cost sharing improves access to physical therapy providers while not materially
increasing the healthcare expenses or premium dollars.
o Actuarial analysis of co-pay legislation in Missouri indicates that capping PT co-payments at
$20 per visit would result in a premium increase of only 80 cents per month.
o A study by Optum Insight concluded that the impact of decreasing the copay from $50 to $30
is 37 cents per member per month.
 The issue of fair physical therapy copayments has been recognized nationally. Seven (7) states have
passed legislation to address this issue (Iowa, Arkansas, Connecticut, Kentucky, Missouri, New
Hampshire and South Dakota), with many more states in the legislative process on the copay problem.