Download High Copay 2017 - Updated

An Act to amend the insurance law, in relation to physical therapy services [S5764-A (Defrancisco) / A659-A (Cahill)
Senate Cosponsors (0): PREVIOUS COSPONSORS: ADDABBO, AMEDORE, AVELLA, BONACIC, BOYLE,
BRESLIN, CARLUCCI, ESPAILLAT, GALLIVAN, GOLDEN, KENNEDY, LATIMER, MARCHIONE, MARTINS,
NOZZOLIO, PANEPINTO, PARKER, RANZENHOFER, RITCHIE, VALESKY, YOUNG
Assembly Cosponsors (72): CURRENT Cosponsors: Skoufis, Blankenbush, Rivera, Fahy, Barrett,
Weprin, Titone, Brabenec, Murray, Santabarbara, Lalor, Moya, Hunter, Castorina,
Malliotakis, Abbate, Abinanti, Arroyo, Benedetto, Braunstein, Brindisi, Colton, Crespo,
Crouch, Cusick, Cymbrowitz, Dinowitz, Englebright, Farrell, Galef, Garbarino, Giglio,
Gottfried, Graf, Gunther, Hawley, Hevesi, Hooper, Jaffee, Jenne, Kavanagh, Lentol,
Lifton, Lopez, Lupardo, Lupinacci, Magee, Magnarelli, McDonald, McDonough, McKevitt,
McLaughlin, Mosley, Otis, Paulin, Peoples-Stokes, Perry, Pretlow, Quart, Raia, Ramos,
Rosenthal, Sepulveda, Simanowitz, Simon, Stec, Steck, Stirpe, Thiele, Walter, Woerner,
Zebrowski
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Physical therapy is an integral part of health care and the Insurance Law requires health insurers to cover
physical therapy services.
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New studies are proving that physical therapy is equally or more effective than surgery for managing certain
conditions including knee pain and back pain.
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Health insurance imposed co-pays are currently unlimited, often equal the actual cost of the treatment, and
have put necessary physician-prescribed treatment out of the reach of many New Yorkers already paying
ever-increasing insurance premiums.
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Health plans have shifted the vast majority of the cost of physical therapy services by imposing high
“specialist” copayments on consumers. This category is generally reserved for higher-cost services such as
care by neurologists, cardiologists, and neurosurgeons.
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The reality is many patients are paying the full cost of physical therapy care. These are "all-pays" rather than
"co-pays." This is particularly misleading to the patient who expects that the physical therapist is being
reimbursed by the insurance company in addition to their copayment.
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Through this practice, health insurers are avoiding the Insurance Law requirement to cover physical therapy
services severely restricting access to this important health care service
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The real problem is high co-pays are limiting necessary physical therapy, resulting in unnecessary surgery,
epidural injections and expensive imaging studies.
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A 2012 study demonstrated that earlier physical therapy leads to better outcomes. In 32,070 patients who
were newly consulting a primary care physician for low back pain found that those who were referred to a
physical therapist early (within 14 days of consultation) showed a reduced risk of subsequent health care
utilization including decreased utilization of advanced imaging, surgery, additional physician visits, injections
and opioid medications and lower overall health care costs than did those patients with delayed treatment
by a physical therapist.1 According to the study, total health care costs for patients receiving early care from
a physical therapist were on average $2,736.23 lower per episode of care.
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In regards to access, an NYPTA poll conducted in 2010, found that 71% of New Yorkers would be more likely
to receive all necessary physical therapy care if insurance co-pays were lower. As a result, many patients
forego treatment as they cannot afford it. They may then need higher more expensive levels of care for
something that could have been managed conservatively for a fraction of the cost. In some situations such as
back surgeries, joint replacements or other orthopedic, patients can’t afford the physical therapy co-pays
after their procedures and choose to forego care, which then delays recovery or results in failure to benefit
from the surgical intervention.
- Purpose: S.5764-A Limits co-payments for physical therapy to no more than the copayment amount charged for
primary care services. This updated language would be easier for insurers to implement compared to our
previously proposed “20% limitation.” This law does not mandate a fixed cost and allows for the necessary
variability in patient responsibility based on plan type. It will also still allow insurance companies to impose copays to decrease overutilization but will protect patients from these cost shifting practices.
- The Bill has been referred to Senate and Assembly Insurance Committees
*If your legislator is a previous cosponsor of our copay bill please ask that they continue their support of our efforts
to achieve fair physical therapy copayments.
ASSEMBLY Insurance Committee (Kevin Cahill is the Chair and is the sponsor of the bill).
Check to see if your assemblyperson is a member of the Insurance committee.
- If they are a member please ask them to co-sponsor
- If they are a member and are already co-sponsoring please urge them to help the bill get to a vote within the
committee
SENATE Insurance Committee (Senator James Seward is the Chair).
Check to see if your senator is a member of the insurance committee
- If they are a member please ask them to co-sponsor
- If they are a member and are already co-sponsoring please urge them to help the bill get to a vote within the
committee