Evidence Based Rehab

Rising healthcare costs and the health insurance industries continuous push to maintain high profits have lead to higher and higher copays. Especially in PT where insurance companies aren't really sure what they are paying for. It's not uncommon for me to have patients come in with insurance benefits that require a $25-$35 copay per visit. Plus, there is usually some arbitrary visit limit to boot! Many patients balk at this, and our first reaction is to sympathize with them and help make excuses why they don't have to come in, or don't have to come in often. Is this the right approach, though?

A colleague and I just had a conversation today regarding this, and Larry Benz, coincidentally, posted his opinions related to copays over at Evidence in Motion. I won't cut and paste what he states, but I will express my take on the issue.

Do not make excuses for a patient's insurance copay. If you think it's too expensive, then did they really need to be in to see you in the first place? If they need your services, then don't be afraid to let them know and provide them with that service.

Another issue in the area I work in is the difference in copay for a PT owned outpatient clinic vs. a hospital run outpatient clinic. Basically, the PT owned copay is high and the hospital has none. What does one do in this situation? Refer to the hospital to "save" the patient money? If so, then what does that say about your business and your beliefs about your clinical skills when you confirm to this patient that the clinic choice doesn't matter, only the cost (so choose the cheapest?).

In the end, if you are providing quality, outcome oriented, evidence-based treatment, then you should let that prospective patient know that and then give them their moneys worth for treatment without letting that high copay rule over you.

Labels: Copays, Direct access, Healthcare, insurance, physical therapy