Cracking Down on Overtreatment: The Alarming 85 Million Won Bill for a Year of Physical Therapy

Excessive Non-Covered Physical Therapy Raises Concerns in Insurance Industry

Concerns Over Lack of Standards for Non-Covered Treatment

As of August this year, the actual loss insurance money paid out for non-covered physical therapy exceeded 1.5 trillion won. There are concerns both inside and outside the insurance industry that lack of standards for non-covered treatment could lead to excessive treatment and excessive payment of insurance benefits.

Rising Insurance Premiums and Excessive Treatment

According to data received from the Non-Life Insurance Association, the actual loss insurance money paid for non-covered physical therapy through August of this year was calculated to be 1.562 trillion won. The actual loss insurance premium for non-covered physical therapy, which was around 1.8692 trillion won in 2022, surged to 2.127 trillion won last year. If the current trend continues this year, it is expected to exceed 2 trillion won.

Abuse of Non-Compensated Care

The scope of doctors who prescribe and perform non-reimbursed physical therapy such as manual therapy, extracorporeal shock wave therapy, and proliferative therapy is not set, and treatment costs vary widely depending on the medical institution. As a result, abuse of non-compensated care may occur.

Case Studies: Excessive Physical Therapy and Insurance Claims

Mr. A received inpatient and outpatient treatment at eight medical institutions for about 11 months last year, received 342 sessions of uncompensated physical therapy, and claimed actual loss insurance amounting to 85 million won. Mr. B was admitted to two medical institutions alternately and received a whopping 694 sessions of uncompensated physical therapy over the course of a year. The insurance money he claimed was 65 million won.

Need for Standards to Eradicate Excess Physical Therapy

Such leakage of actual loss insurance money due to excessive physical therapy may lead to an increase in insurance premiums, causing harm to many people. The non-life insurance industry believes that standards for non-reimbursed treatment are necessary to eradicate excess physical therapy.

Call for Guidance from Financial Authorities

Rep. Kang pointed out, “It is questionable whether receiving manual therapy hundreds of times and costing close to 100 million won has anything to do with normal patient treatment,” and added, “We need guidance from financial authorities so that insurance companies can control excessive treatment based on reasonable standards.”