“Flipping the Pyramid” on Healthcare Norms

By Amy Mourad, PT:

Start at the top!

In the typical medical model that we have all become accustomed to, there are a series of events that follow an injury: rest, see a physician if symptoms persist, get tests/take medications, follow up with physician, and maybe, finally get a referral to physical therapy. What if you could just jump the line and head straight to the physical therapist’s office for your injury? Guess what? You can!

California is one of 26 states which have direct access to physical therapy services. The term “direct access” means that you do not need to see a physician to be referred to physical therapy, and that you can “access” a physical therapist “directly” when you believe it would be beneficial for you!

You may have heard of direct access for physical therapy services, but do you know how it works? There are some provisions to providing direct access physical therapy services. After a physical therapy evaluation, you can be seen for 45 days or 12 sessions, whichever occurs first.  If the PT feels as though you are presenting with symptoms outside the scope of physical therapy, they must refer you to see a physician first before continuing with treatment. Also, if you are not showing signs of progress within a timely manner, the PT is required to refer you to see a physician. After the 45 days or 12 sessions are up, you must see your MD and have a planned of care signed to continue care, even if you are making excellent progress with PT. 

The benefits of utilizing direct access are both financial and functional. Numerous studies have been published sighting decreased cost to both the patient and insurance companies when the patient sees the PT first. The Mitchell study reports that when a person sees their doctor and is then referred  for physical therapy, the total episode of care is 2.2x more expensive than if the patient goes to PT first! Coming directly to physical therapy, expedites your care which leads to less time in physical therapy, fewer unnecessary tests and better outcomes!

Many insurance companies (except HMO plans) will cover physical therapy services without a doctor’s prescription. HMOs require referrals, so you must still see your primary care physician first. Of course, you are always allowed to pay privately for therapy.  

Not sure if physical therapy would be helpful for your injury or if your insurance allows you to come directly to us? Give us a call and we would be happy to discuss your situation and do a complimentary insurance benefits check.

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