Many “Direct Access” states allow patients to see a physical therapist without a referral from your doctor. If your state is included, make sure to contact your insurance company to see if they will cover physical therapy.
What if My Insurance Company Requires a Referral for Physical Therapy?
If you want to see a physical therapist, but your insurance company requires a referral in order to cover the care that you will receive, you will need to obtain that referral. The only exception to this is if you are willing to cover the costs of physical therapy yourself.
To obtain the referral, make an appointment with your primary care provider.
Acceptable providers include a physician, a physician’s assistant, or a nurse practitioner. Discuss the issue you are having and express an interest in physical therapy.
If the medical provider approves, they will provide you with the referral needed by your insurance company. If not, they will inform you of other options you have at your disposal.
Physical Therapy Referral Guidelines
As of the January 1st 2015, all of the states, the US Virgin Islands, and the District of Columbia allow all individuals to obtain some level of care from a physical therapist without having been previously prescribed or referred.
However, there are some jurisdictions where physical therapy treatment is directly limited by the state’s laws through arbitrary restrictions.
This is because of the fact that certain states do not recognize the educational training of those that work in physical therapy. Additionally, they do not directly serve the individual needs of the patients needing physical therapy unless the patient’s care is prevented or interrupted by the restrictions in place.
The restrictions that are in place that are part of the physical therapy referral guidelines typically include the following:
- The amount of time that a patient is allowed to spend with a physical therapist, per session.
- The number of visits that a patient is allowed to treat the issue in which they are being seen or treated for.
- Specific requirements which must be in place under certain types of diagnosis provided by medical care providers.
- Physical therapy being limited based on the population in which a patient is part of.
- Having to have a medical referral in place for the advancement of physical therapy treatment.
Direct Access Physical Therapy
Direct access physical therapy is a form of therapy that is permitted to be obtained by patients for evaluation and treatment without the need to have a medical provider referral in place.
While every state and District of Columbia and the Virgin Islands in the US does allow some degree of direct access for patients, many of the states within the country continue to place restrictions on physical therapy treatment or they only permit patients to get physical therapy for themselves and without the use of a medical referral in very limited situations and/or circumstances.
How Do the Restrictions Affect Patients and the Healthcare Community?
The restrictions that certain states impose on direct access physical therapy have many negative consequences – for both the patient and the healthcare community.
If a patient could benefit from physical therapy, it delays their treatment, care, and recovery from the medical issues in which they suffer. This results in higher expenses for the patient and the healthcare system.
Furthermore, the restrictions may result in decreased functional capability of the patient, high levels of frustration, and the dependency on medications that could – otherwise – be avoided by simply having physical therapy treatment.
Direct Access Physical Therapy States
To date, there are a total of 18 areas that allow patients to have full direct access physical therapy. These include the following:
The following 26 regions allow patients to access physical therapy treatment, but with specific provisions:
District of Columbia
The following regions offer extremely limited patient access to physical therapy treatment:
Are Physical Therapists Trained to Provide Medical Care Without a Referral?
Due to the state restrictions that are in place that prevents many from experiencing the full benefits of physical therapy treatment without a medical referral, many are curious if physical therapists have the qualifications to provide care without a medical referral.
The short answer is “yes”.
The education that PTs receive is post-baccalaureate. In addition to this, physical therapists must also undergo a highly comprehensive clinical training program. As a result, these professionals are able to examine, thoroughly evaluate, officially diagnose, provide a prognosis, and engage in the intervention of individuals that have functional-based limitations, specific impairments, and even disabilities.
If a physical therapist works with a patient that they deem to have symptoms that are considered insistent with their medical diagnosis or out of their given area of support, they will immediately refer a patient to a medical care professional, such as a physician.
Insurance companies do not view physical therapy treatment as a risk to patients. This is why they cover the treatment. As mentioned previously, though, some insurance companies do require a medical referral in order to cover the physical therapy treatment that a patient has.
If you are unsure as to the guidelines of your insurance company, you should direct the inquiry directly to your insurance provider.
Is It Common for a Physical Therapist to Be Charged with Malpractice?
The answer to this is “no”. In fact, when it comes to malpractice, claims, and complaints, physical therapists have very low rates of these incidences.
If a physical therapist finds that your symptoms, signs, or health is beyond the scope of care in which they provide, they will immediately refer you to a medical professional before proceeding in their treatment. They place a very high emphasis on protecting the health of the patients in their community, the safety of their patients, and their general welfare.
Practice Without Referral
Most agree that allowing patients to make their own decisions about the health care that they receive is not only an ideal policy, it is their right. By having direct access physical therapy in place and eliminating the need for a patient to obtain a referral, it is allowing a higher level of accessibility when it comes to health care.
The education and training that a physical therapy received provides full support for the professional to practice without the need for referral. Research, studies, and medical evaluations have determined that physical therapy is a safe and effective form of treatment. Despite this, numerous states continue to place restrictions on these services.
Safest Approach to Pain Management
In a world that is currently facing the most severe opioid crisis, physical therapy is considered to be the safest approach to pain management. Most medical professionals resort to opioid-centric treatments for individuals that suffer from pain; however, this is led to a very widespread misuse among patients, high levels of addictions, and many deaths.
Physical therapists are capable of changing the ultimate trajectory associated with this health crisis. This is made possible by teaching the patient how to manipulate and work their body in order to gain control over the pain in which they experience.
Those that receive physical therapy treatment will have a more positive outcome than those that must resort to potentially addictive medications that are commonly prescribed for pain.
Take Charge of Your Health Today
Physical therapy helps patients save millions of healthcare dollars. Movement is considered to be the absolute best medicine. Nearly all medical conditions and symptoms may benefit from the use of physical therapy treatment.
If you feel the need to see a physical therapist, you should pursue treatment.
If you live in a state that does not provide full direct access, a referral will be required if you need your insurance to cover the expense; however, this is much better than suffering from the effects of prescription medications or undergoing unnecessary surgery.