APTAMD’s Fair Copay Legislation Bill

Senate Bill 725 / House Bill 974
Health Insurance – Physical Therapy – Copayments, Coinsurance, and Deductibles

The Opportunity is Here and Now to Make an Impact on the Patients and Communities, you Serve

Bill Sponsors
Delegate Nic Kipke (District 31B – Republican)
& Senator Cory McCray (District 45 – Democrat)

FOR the purpose of prohibiting insurers, nonprofit health service plans, and health maintenance organizations from imposing a copayment, coinsurance, or deductible for covered physical therapy services that is greater than the copayment, coinsurance, or deductible imposed for a primary care visit under the same plan or contract; requiring insurers, nonprofit health service plans, and health maintenance organizations to state in each plan or contract the coverage requirements, limitations, conditions, and exclusions for the provision of physical therapy services; and generally relating to health insurance and physical therapy services.

In our current insurance system:

  • Frequently physical therapy patients encounter challenges with commercial carriers through the imposition of high cost and wide-ranging copay and cost share requirements.
  • In some cases, more than 50% of the cost burden falls on the patient through cost-share fees imposed by the insurer.
  • This becomes a tremendous financial barrier to care when the patient is asked to pay more out of pocket than what the insurer reimburses the PT.
  • High copays can lead to patients managing chronic or acute pain with low-cost opioids, which can lead to addiction, dependency, and death.
  • High copays are a significant disincentive to care that disproportionately affects disadvantaged communities and lower-income patients.
  • Insurance providers are setting co-pay rates at a level that has shown to decrease the utilization of physical therapy services. [This affects all patients but has disproportionately impacted lower-income patients].

We Need Your Help!

  • Help us share testimonials with legislators from patients and providers. We created a portal for patients and providers to share their stories  on how high copays have impacted care.
  • Schedule a meeting with your district legislator to let them know about the bill and why YOU want them to support this legislation.

Learn More