The 2009 New York Physical Therapy Association (NYPTA) legislative agenda targeted the unfair practice of insurance companies designating physical therapy services as “specialist”; originally meant to offset the high cost of paying for specialty services of surgeons and other physicians who only see a patient one time for expensive consultative service. By contrast, physical therapists, who have been granted legal “direct access” as a primary care provider, may see a patient multiple times per week for an extended duration.

There are many reported cases where the patient co-pay is $50 and the allowable charges by contract with the provider were actually less ($45); the actual insurance cost for the visit is $0 and the patient pays the full amount. This impacts the patient by limiting access due to the excessive financial burden placed on them, and challenges the therapist with unrealistic expectations for optimal outcomes as a result of too few treatment sessions.

While recognizing the unfairness of this practice, Legislators have been encouraged to eliminate the “specialist co-pay” loophole and bills have been introduced in both the NYS Assembly (Kevin Cahill- A8171) and Senate (Neil Breslin- S4321). In fact, on Lobby Day this past May, Legislators themselves shared their own stories about family and friends who have been adversely affected by high co-pays; limiting access to care. Both bills sit in committee, not considered the most pressing issue before the Legislature, and we need continued pressure to push the issue to the forefront and demand action.

We’d like these bills passed on or before 2010. Please contact your legislator and let them know you want this change, of an unfair insurance practice, to happen.