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2016 Legislative Update
A Physical Therapist View
On the ballot this early November in SD is Initiated Measure #17, “The Patient Choice Initiative”, and I urge you to vote Yes on 17. The measure simply requires health insurance companies to allow all willing and qualified providers equal access to becoming a network provider, and ultimately will allow you as a patient to decide what Doctor or Therapist is best able to care for you, not just the Doctor or Therapist whom the insurance company decided you must see. It allows small independent PT’s and Dr’s to treat and care for you for the same reimbursement and coverage that the giant healthcare networks are allowed.
Currently, Pro PT, like all providers, has to apply to each insurance company to become a “provider” for each particular insurance company. We are told by the insurance company what they are willing to pay for our services and we have little input to the negotiation of what those rates and payments will be for our services. After we agree to what the insurance company wants they then are able to decide to allow us to be a provider or deny us provider status even though we are willing to agree to their terms. Yes on 17 simply says if we are qualified and willing to agree to their terms, they must allow us to be a provider.
Why on earth would an insurance company deny us provider status if we are agreeing to the terms and rates they have set and are paying other Dr’s and Therapists with the same qualifications, you ask? Well, what has happened in SD is that the 3 major insurance carriers of SD have the same name as the 3 big Hospital systems in the state; Avera, Sanford, and out west Regional health systems. Each of these systems want you or your employers group plan to buy their particular insurance and then if you need healthcare they can make sure you are only treated at their facility, by their Dr’s and by their Therapists.
Let me give you a simple example, if you have “Big Cat Insurance” and “Big Cat Health Systems” has a PT clinic in your community, “Big Cat Insurance” is allowed to Deny “Hometown PT” as a provider, even if “Hometown PT” is willing to agree to the same rates (no increase in “cost” as the TV ads claim) as the “Big Cat” clinic does. In this scenario, you can only have Therapy provided at the “Big Cat Facility” not at “Hometown PT”. This same scenario applies to Doctors, Chiropractors, Optometrists, Physicians Assistants, Dentists and Yes on 17 is supported by all of these medical associations and is opposed by guess who….. Insurance companies and the hospitals that they are affiliated, with threats of higher cost and government control when it will simply cost the same and allow for the healthcare market to be free to let you choose.
Currently in SD, your Insurance Company is allowed to choose the providers you are allowed to see and Yes on 17 corrects that and gives you the Patient the Ability to Choose whom you want to care for you.

Please Vote Yes on Initiated Measure 17
Bump Anshutz PT
Pro PT Huron and Brookings

http://www.sdpatientchoice.org/
No advance notice
This past April we were informed on a Friday that the following Monday our insurance was implementing a new "Tier 1" Program. It said "Tier 1 is a way for you to save money on certain services performed at approved Tier 1 facilities." The program was not going to save my family or I on any services. I either had to use one of their Tier 1 facilities and pay the same amounts I always had for specified services or I had to pay a higher out-of-pocket cost and co-insurance if I chose a different facility.

My husband has an autoimmune disease that he sees a Gastroenterologist for. With this new program, if he has to have a procedure done we can no longer see his Doctor that has been with him since his diagnosis unless we want to spend thousands of dollars extra. The only option in the whole state is Sioux Falls Specialty Hospital, which only has two gastroenterologist. Every person in the state that has this insurance and needs a gastroenterology procedure will have to go to Sioux Falls and have two doctors to choose from. That means if you live in Rapid City, you have to drive to Sioux Falls, or pay more.

If Initiated Measure 17 passes we will have the option to continue to see his current Doctor and not have the insurance company tell us that we need to switch hospitals and doctors. It will not raise costs as people are trying to say because the providers still must meet the terms of the insurance company, meaning they will do the same procedure for the same price as the preferred facilities already are. There is no extra cost for the insurance company. Please vote Yes on 17 so that we can be the ones to decide which doctor is most qualified to take care of our loved ones.
Nancy's Story

"Our insurance changed and I was told that I could not use my doctor who I was comfortable with." - Nancy
Mike's Story

"Why do we pay for insurance if it's not going to help us when we need it?" - Mike
Cathy's Story

"I was lucky to have found out in advance. Why couldn't I get it here like before?" - Cathy
Pam's Story

"Gasping for air all the way across the state? I don't think so." - Pam
My Insurance nightmare.

I lost both of my kidneys 7 years ago due to a genetic disease that I have lost most of my family to. Both of my siblings have the same disease and will someday also lose both of their kidneys. Along with this disease are other issues such as brain, spine, eye, ear pancreas, liver and adrenal tumors. We suffer with most of them.

The physician that I have been with since the loss of my kidneys is exactly the doctor that I need as he is not only a Nephrologist but also works in Neurology. He is very aware of all my issues.

My wife recently changed jobs and we were told by the transplant team where I am signed up that if I choose to be on the policy that is provided by my wife's employer it will be an issue. I would not only be taken off the transplant list, but I will not be able to see my physician.

It is hard to explain the stress that we have been under due to this issue. We have been put in a position that no one with physical disabilities should have to deal with. We deal with enough every day just to put one foot in front of the other. I should not have to also be saddled with finding new health care providers just because one facility want to make more money than the other. It seems to me that they are not for profit facilities and should stand on their own two feet by providing the best care possible for each and every patient.