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Physical therapy

Carmel LaFrance of Whitehall, 91, works out to gain strength so she can return to living on her own in her house of 67 years. Physical therapy like this is essential to helping patients return to independence, but therapists say copays and high-deductible insurance plans are preventing access to needed rehabilitation. 

Patients are forced out of physical therapy before regaining use of their limbs because of high copays and deductibles, physical therapists said.

They marched in Albany on Monday for Lobby Day, pushing for state legislation that would put limits on copays.

A bill has been introduced and was referred to the Assembly and Senate insurance committees.

It would require all insurance companies to stop charging the “specialist” copay for physical therapy. That means the copay would be the same as the copay for seeing a primary care physician.

The bill would help Medicare patients, who pay a copay for physical therapy. But it would not help those who have high deductibles instead of copays.

Still, it’s a start, said therapist Denise Buher, who has offices in Queensbury and South Glens Falls.

“It’s gotta be at least 10 patients a week who tell me, ‘I can’t afford to come,’” Buher said. “These copays are now higher than what we are allowed to get paid.”

Many copays are $50, she said, but many insurance companies pay her a maximum of $47 for an hour-long session. She ends up giving patients a $3 refund because of it.

“Those specialty copays were set for cardiologists. We should not be in the specialist copay realm,” Buher said. “Patients shouldn’t have to pay more than 20 percent of the bill.”

She argued that patients don’t really have a copay for physical therapy — they have an “all-pay.”

“They are not really getting physical therapy benefits. The insurance is paying nothing,” she said.

And it is having real impacts. Treatment after major surgery is usually three times a week for six to eight weeks, but that’s $850 to $1,130.

“People can’t afford it,” Buher said. “Every day, people leave. It happens all the time. It’s so frustrating.”

Recently, a patient who had ankle surgery told her that she can’t afford to continue therapy.

Buher is worried about patients like her.

“Ankles are tough because they have to go in a progression,” Buher said.

First, while the patient is restricted to non-weight-bearing, the therapist works to get full range of motion back. Then the patient begins to stand while wearing a protective boot. The final phase in ankle therapy involves walking without the boot. The whole progression takes six to eight weeks, Buher said.

Leaving early can cause a cascade of other health problems.

“If you lose range of motion in one of those joints, it affects how the body moves,” she said. “It interferes with their knee, their hip, their back. It just breeds dysfunction.”

A patient who needed hip surgery ended up needing back surgery as well because of damage caused by walking at an angle due to the hip injury, she said.

She has a patient with a back injury who can’t afford enough therapy to get well.

“He comes in once a week. He feels great for two days,” she said.

If he could come three times a week, she said, she could gradually increase his strength and reduce inflammation. But she can’t keep up with the amount of injury put on his back between weekly visits.

“This guy has just resorted to the fact that he’s always going to have this,” she said.

He is one of many of her patients who is usually in pain, even though she knows how to fix the problem.

“These are not hopeless cases. Patients improve tremendously with physical therapy,” she said. “But with these copays, and now with these high-deductible plans, patients have no access to physical therapy. They just can’t afford it.”

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You can reach Kathleen Moore at 742-3247 or kmoore@poststar.com. Follow her on Twitter @ByKathleenMoore or at her blog on www.poststar.com.

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