Please contact your Georgia State Senator and ask him or her to support Senate Bill 164, sponsored by Senator Fran Millar. This bill will help reduce the out-of-pocket amount a patient has to pay for Physical Therapy, Occupational Therapy and Chiropractic Care by prohibiting a health insurer from charging a copay that is greater than that of a primary care physician or osteopath.
Read more about the need for Fair Copays in Georgia and how SB 164 helps address this issue …
Background and Problem:
Physical therapy (PT) has been proven to be as effective as surgery for conditions such as meniscal tears knee osteoarthritis, rotator cuff tears, spinal stenosis, and degenerative disk disease.
Further, manual therapy, exercise and education provided by a physical therapist is a proven supplement to prescribing opioids. In fact, the Centers for Disease Control and Prevention (CDC) is urging health care providers to reduce the use of opioids in favor of safe alternatives such as PT, OT, and chiropractic care.
Physical therapy, occupational therapy, and chiropractic services typically fall into the category of “specialist” under most health insurance plans – a classification that is accompanied by higher copayments.
Some areas of specialized care only require a copayment on the first visit – with all follow-up visits covered under the initial copay. However, typical PT, OT, and chiropractic treatment plans require multiple visits, and this higher copay must be paid at each visit – creating a barrier to access for patients.
The number of required visits within a treatment plan is highly variable, and often depends on factors such as diagnosis, severity of impairments, and past medical history – just to name a few. However, it is safe to say that most patients require multiple visits.
Imposing higher copays is a problem for many patients. Insurers are limiting the frequency and duration of care a patient can afford. The Physical Therapy Association of Georgia (PTAG) gathered data to illustrate the financial burden of higher copays for PT – revealing the lowest copay of $30 – and some as high as $75 – with the average copay for PT being $51.25.
Based on this average, a patient required to visit a physical therapist 2 times a week for 4 weeks is paying $410 in out-of-pocket health care expenses. This example is a conservative estimate – as there are many Georgians paying even greater out-of-pocket medical costs. However, if these same patients were paying the average copay for a primary care physician of $25, they would pay only $200 in out-of-pocket expense – a savings of more than $200.
SB 164 seeks to remove the barrier to care created by high copays. This bill prohibits a health insurer from charging a copay for PT, OT, and chiropractic care that is greater than that of a primary care physician or osteopath. SB 164 will do the following to benefit Georgia’s health care consumers:
- Save money by reducing out-of-pocket medical expenses;
- Allow greater compliance with the plan of care leading to improved outcomes and less downstream health care costs for insurers
- Provide a safe alternative for the use of prescribed opioids
High copays are restricting patient access in Georgia. SB 164 will open access and allow Georgians to seek necessary care by reducing high copays.
Some may argue that passing SB 164 will result in insurers raising the copay for primary care physicians. However, there is absolutely no evidence to support the claim that primary care copays would go up – as this has not happened in the eight other states that have enacted similar legislation.