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Insurance copays have your patients seeing red?

Rehab Regs, January 1, 2005

Here's how to ensure that they still receive the therapy they need

If your patients have complained about higher copays and deductibles from their insurance carriers, you're not alone.

"As we head into 2005, the costs are too high for [patients'] employers to give them the same coverage they had in 2002, says Rick Gawenda, PT, director of rehab services at Detroit (MI) Receiving Hospital. "[Higher co-pays] affect therapists because any time costs are shifted to the consumer, they tend to watch their money more and not go to therapy as often."

For example, if a patient had an injured knee and did not have to pay a copay for each visit to his PT, he wouldn't think twice about attending therapy three times per week for six weeks.

But if he had a $20 copay for each visit, he now pays $60 per week for his visits, or a total of $360 for that series of rehab visits. Depending on his financial situation, he may decide not to attend therapy as much as he should.

Similarly, some insurance companies require patients to pay deductibles before their coverage kicks in. Even then, their insurance may only cover 80% of the costs of service, leaving patients to continue to pay the remaining 20% for the total treatment time.

Because many insurance companies pass along the effects of higher healthcare costs to consumers in the form of higher deductibles and copays, almost every rehab facility in the country feels the crunch.

At Ortho Care Physical Therapy in Roseville, MI, facility management makes a special effort to let patients know what their individual plans will require of them before treatment begins.

"If the patient has a deductible over $500, we try to encourage them to come in for their first visit, and then we can give them an idea of how many [more] visits they will need," says Susan Borninski, MS, business director at Ortho Care.

Ortho Care also offers payment plans to patients who may not be able to afford an additional weekly expense such as paying a copay three times per week. This practice may also encourage patients to attend therapy as frequently as they need it.

"We'd rather work on a payment plan with a patient than drop down to attending therapy just two times a week," says Borninski. "Our number one goal is to maintain therapy three times a week for four weeks, or as directed by the physician."

Gawenda offers the following tips to keep patients in therapy:

$ Give patients one-on-one attention. Rather than getting the patients settled and periodically come back in to check on them, spend some quality time with them and ask them questions.

"If they're paying $20-$30 a visit, do they feel like their getting the bang for their buck?" says Gawenda. "Give them individual time and help them understand the importance of their rehab."

$ Negotiate an appropriate treatment plan. Therapy three times per week for four weeks may not be appropriate for every patient, says Gawenda. You may be able to modify their treatment to work within their financial constraints.

"When a patient starts therapy, look at what his or her insurance is, as well as the copay and deductible," says Gawenda. "Take [these factors] into account when considering the frequency and duration of therapy."

$ Shift more responsibility to the patient. Home exercise programs (HEP) are essential to any rehab treatment plan. For patients who need to reduce their weekly visits to you because of high copays, their HEPs become even more important. Because they won't visit your facility as often, you must stress the value of following through on their HEPs.

$ Educate the patients. You can't work within patients' means unless they first understand what their portion of the financial burden is. Before they begin therapy, let them know what is covered and what they should expect to pay.