Insurers save money, but patients forgo treatment
Published: 2010-07-18 15:55:46By: Donna Evans-Deyermond | Buffalo News | April 3, 2010
Last fall, my years of abusing my back finally paid off. Pain and numbness in my left leg were keeping me from my usual hectic pace.
My doctor and I elected for physical therapy, hoping it would keep me away from that more expensive and invasive option: surgery. The costs were $10 copays plus some sweating and groaning doing exercises to strengthen my core.
While I was in treatment my daughter called me in serious pain, asking for my exercises. We knew she should really go to physical therapy herself, but anything seemed better than nothing. She didn’t mind the sweat and groaning, but couldn’t afford the $40 per visit co-pay her health plan required.
When I related this to my therapist he put me in touch with Patrick S. Privatera, president of the Physical Therapy Alliance of Upstate New York. Privatera told me that although reimbursements vary from insurer to insurer, one benchmark is Workers’ Compensation, which in Western New York pays about $47 per visit. Another benchmark is Medicare, which uses a complicated system called the Resource- Based Relative Value Scale. Depending on the treatment and length of visit, on average, Medicare reimburses $60 to $70.
Privatera said Workers’ Comp
reimbursements have not increased since 1996, and although other
insurers have had minor increases, they have far from kept up with
inflation. Patient co-pays, however, have increased from a typical $10
per visit to my daughter’s $40. So insurers that used to pay $35 for a
visit now pay $2, and people like my daughter forgo physical therapy
because they can’t afford it.