Physical therapy is proven to help patients heal faster and better from all sorts of conditions. However, getting the treatment you need can be difficult if your insurance does not adequately cover the cost of PT services. Thanks to a collaboration between the American Physical Therapy Association (APTA) and insurer UnitedHealthcare (UHC), the cost barrier is coming down.

UHC launched a pilot program in Connecticut, Florida, Georgia, North Carolina, and New York that waives the cost of copays and deductibles for three physical therapy sessions for patients with low back pain (LBP). The pilot, which could affect as many as one million enrollees, went into effect on July 1, 2019. Other states will join the program in 2020 and 2021.

This pilot comes on the heels of a multi-year collaboration between APTA, OptumLabs, and UHC that included publication of a study in the American Journal of Managed Care. This study found that higher copays and payer restrictions on provider access may steer patients away from more conservative treatments for LBP—including physical therapist and chiropractic services. 

Creating an Easier Path to Better Care

According to APTA, the study’s authors hypothesized that patients with LBP who had easier access to a wider array of providers and lower out-of-pocket costs would be more likely to first seek out conservative approaches such as physical therapist or chiropractic services.

Researchers looked at five years of claims data from OptumLabs Data Warehouse for 117,448 adult patients to determine the relationship between health plan benefit design and patient choice of primary care physician (PCP) versus a physical therapist or chiropractor as the first-line provider for new-onset LBP.

For the analysis, authors divided the patients into two groups: those who first sought treatment from either a PCP or a PT, and those who first sought treatment from either a PCP or chiropractor.

Their findings include:

• Fewer restrictions on provider access was associated with higher likelihood of seeking out physical therapy or chiropractic treatment. 
• Higher copayments decreased the likelihood of a patient seeing a physical therapist as first provider. 
• As deductibles increased, the odds of a patient seeing a PT first declined. 

“Our study has demonstrated that patients experiencing LBP are moderately responsive to network restrictions and cost sharing in their choice of entry-point provider,” the study authors noted. “Reductions in spending are not necessarily accompanied by improvement in value, particularly if patients bypass routine care that would prevent higher downstream costs.”

The Economic and Healing Benefits of PT

As physical therapists, we applaud the UHC pilot program. We hope that it inspires all insurance providers to remove the barriers that might keep their members from seeking PT as an effective treatment for a wide range of conditions, including:

• Orthopedic/sports injuries, such as knee pain or frozen shoulder
• Senior care, including osteoarthritis or fall prevention
• Back and neck pain, such as sciatica or spinal stenosis
• Specialty care, including oncology rehabilitation or fibromyalgia
• Focused training, such as a gait analysis or a strengthening program 

Recent research by the University of Michigan, commissioned by Luna, shows that healing goes up and costs go down when injured patients seek timely PT treatment. The study reveals that getting a patient into treatment within 48 hours of injury can—within a three-week period—make a significant difference in healing, chronic pain patterns, biomechanics, and substitutions. Early care also avoids pharmaceutical intervention, diagnostics, and even costly procedures.

The results are clear—direct access to physical therapy, such as at-home care, speeds healing and can lower costs for insurers, patients, and providers. It’s a win-win all around.

Learn more about the UHC pilot program and related study here.