New York Physical Therapy Association Calls on Legislature to End Insurers Application of High Copays

Disproportionately High Copays Limit Access to Care and Cause Unfair Financial Burden on Patients

ALBANY , NY (04/03/2013)(readMedia)-- The New York Physical Therapy Association is calling on the New York State Legislature to enact legislation that would prohibit health insurers from applying disproportionately high copays to physical therapy care. Many commercial health insurers currently require their subscribers to pay the higher "specialist" copay for physical therapy care. The application of the higher "specialist" copay causes an unfair financial burden on patients and, because it oftentimes exceeds the total allowable amount for a visit to the physical therapist, shifts the entire cost of care from the insurance company to the consumer. This practice -- which can lead to foregone treatment or alternative, more invasive treatments for patients, the loss of patients and jobs for physical therapists, most of whom are small businessmen, and a more costly and less effective health care system for all New Yorkers -- would no longer be permitted under legislation now pending in Albany.

"We support A.1666/S.2319 on behalf of our patients and our profession. By limiting the amount of the copay insurers can require to 20 percent of the cost of care or reimbursement rate, this legislation will not only limit out-of-pocket health care costs for patients, it will also help reduce long-term health care costs for New York State by ensuring that patients have access to the most cost effective musculoskeletal rehabilitation care for their needs," said Matthew R. Hyland, PT, PhD, MPA, president of the New York Physical Therapy Association. "We also applaud Assemblyman Cahill and Senator DiFrancisco, sponsors of this bill, for their leadership on this important issue. We believe that passage of A.1666/S.2319 would be a win-win for both New Yorkers and New York's health care delivery system."

It is not uncommon for "specialist" copays to be $50 per visit which, when applied to physical therapy care that can require 10 to12 or more sessions per month, can cost a patient upwards of $500 per month in out-of-pocket costs. Further, the application of "specialist" copays for physical therapy is particularly onerous and unfair given that the maximum amount the insurer typically allows in some parts of the state can be equal to or less than the patient copay. As a result, because the copay is greater than the allowed amount, the insurance company pays $0 for the visit while the patient pays 100% or more of the allowable amount of the visit.

According to research published in the New England Journal of Medicine in 2010 (Trivedi, A, Moloo H. Mor V Increased Ambulatory Care Copayments and Hospitalizations Among the Elderly Vol. 362:320-328, January 28, 2010) high co-pays resulted in patients foregoing ambulatory care and increased health care costs as those same patients utilized more acute care down the road such as hospital admissions. The authors of that study concluded that "raising cost sharing [co-pays] for ambulatory care among elderly patients may have adverse health consequences and may increase total spending on health care."

On April 30, 2013, hundreds of physical therapists, physical therapist assistants, physical therapy students and patients from across New York will be in Albany to draw attention to this important issue and urge the legislature to support A.1666/S.2319 at the New York Physical Therapy Association's annual Lobby Day.



The New York Physical Therapy Association is a professional, non-profit association of approximately 12,000 Physical Therapists (PTs), Physical Therapist Assistants (PTAs) and PT/PTA students. The NYPTA is dedicated to serving the public's health interests, improving the standard of health for people of all ages and advancing the benefits of physical therapy and the interests of physical therapy professionals in state of New York. To learn more about the New York Physical Therapy Association please visit