The Issue:
Patients across Kentucky who needed to access physical therapy (PT) were being charged specialty-level co-pays every time they visited a PT clinic. For example, if a patient had a knee injury and visited their primary care doctor and paid the original co-pay (never more than Twenty dollars) for that visit he/she did not pay another co-pay for any follow up visits or for visits to an orthopedic doctor. If surgery was then required the original co-pay continued to cover the services that were needed.
However, after most surgeries of this nature physical therapy is required for several weeks after the operation. In some cases patients were told to access physical therapy three to four times per week for several weeks. Once patients realized that each time they visited the PT they were required to pay a specialty co-pay rate (typically between Fifty and Seventy-Five dollars) they discontinued their therapy services. Some patients were paying as much as Seventy-Five dollars per visit – totaling hundreds of dollars per week.
The Action:
The KY Association of Physical Therapists joined forces with the KY Association of Occupational Therapists and we set forth a strategy that involved meeting with the Department of Insurance and the KY Association of Health Plans to determine if there was a way to remove the specialty level co-pay without having to introduce legislation. The KY DOI revealed that there were only two levels of co-payments – Primary Care Doctor levels (Range Five Dollars to Twenty Five Dollars) and Specialty Level co-payments that encompassed specialty doctors such as heart and brain surgeons (Range Fifty to Seventy Five Dollars). It was clear that without legislation both DOI and Health Plans would continue to treat PT’s and OT’s as specialty level practitioners.
We mobilized our patient community by asking them to fill out post cards addressed to their legislators asking them to make a statutory change. We reached out in action alerts to our 2,000 members across the state and asked them to call their legislators. Students at UK, Hazard and WKU became involved and made multiple trips to the Capitol to lobby on behalf of the legislation. We created research documents that explained to legislators that it is less expensive for the health care insurance industry to rehabilitate patients to avoid costly surgeries, or in other cases, it is less expensive to rehabilitate them after surgery to avoid further damage.
The Result:
We were successful in passing legislation that removed the specialty-level co-payment from physical therapy and occupational therapy visits. Today a patient seeking rehab at one of our clinics cannot be charged higher co-pays than what they pay their primary care doctor. In most cases our patients are paying five dollar co-payments to access therapy. This has resulted in patients continuing their important therapy until the end of the prescribed time period.