HB 4426 restores fair access to physical and occupational therapists to so many West Virginians that have been unfairly denied ability to attend physical and occupational therapy even at the direction of their physician because of excessive and increasing co-pay amounts.
Points to make when leaving a message for members of both the Banking and Insurance Committee and the Judiciary Committee include:
• Co-pay rates for physical therapy visits have increased significantly in the last two years from $0--$10 to $35-$100 each visit. • Typically a PT prescription for visits can be one-to three times a week for a limited number of weeks. • Physical Therapy costs to an insurance company is generally 1-2% of their total expenditures and they are now charging the majority of it to the patient through the higher co-pay rates • Co-pay rates come directly from the patient pocket at the time the service is provided. • The impact is patients are not continuing on with PT visits and they do not get the needed after surgery care they need for a full recovery. • Patients are being saddled with higher deductibles and now much higher co-pays for the same service. Ask legislator to support HB 4426.
Physical Therapy CO-Pay Issues: Lead. There is an ever increasing co-pay burden on the PT patient often making care unaffordable. Many insurance companies consider a PT visit/treatment the same as a physician specialist. Examples were provided; including Federal BC/BS has $75 co-pay if services are provided by hospital outpatient department. As an aside to the PT issue, PEIA will now have a $500 co-pay (subject to deductibles and co-insurance) for procedures that are often referred to physical therapists for post-operative care. These include spine procedures, knee and hip replacements, and shoulder surgery. Committee members felt we need to be proactive. Similar legislation completed in KY. Need to define the scope of problem with our members and possibly other providers (OT, SLP, chiropractors).
