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February 14, 2013

Letter: High copays limit Georgians’ access to physical therapy

Physical therapists are “specialists” according to many Georgia insurance policies. Physical therapists help people of all ages recover from and prevent illness and injury from stroke and heart disease to knee replacements and low back pain.

While it’s true that physical therapists undergo extensive education and training and are considered the most effective in treating movement disorders, the “specialist” label means some Georgians must hand over high copays — in many cases several times per week for months — to receive the care they need.

A copay is the fixed fee you pay to visit your physician and other medical professionals for an office visit and is set by your insurance company. Specialist copays may be more than double what you would pay out of pocket to see your primary care physician.

Physical therapy is not like other specialties. A patient may see a podiatrist or an orthopedist once or a few times to treat an illness or injury. With physical therapy, a patient might be seen many times over the course of weeks or months, meaning some patients face hundreds or even thousands of dollars in copays.

The only option for some Georgians is to limit their physical therapy visits or forego physical therapy altogether.

Physical therapy can help patients avoid expensive and invasive tests and procedures such as MRIs, injections or even surgery. Once you go through all that, guess where you will be directed? In many cases, you will be referred back to the physical therapist.

It’s time this issue is addressed and Georgians not be forced to choose which bills go unpaid each month to afford medical treatment for themselves or family members.

Legislation in other states requires insurance companies to charge copays no more than that of primary care visits, which significantly eases the financial burden on patients who need physical therapy as part of a recovery plan.

In 2011, Kentucky passed legislation limiting physical therapy copays to no more than what is charged for a visit to a physician or osteopath. And in South Dakota, legislation similar to Kentucky’s took effect in July 2012 also limiting physical therapy copays to those of primary care physicians or other practitioners.

Barney Poole

President, Physical Therapy Association of Georgia

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