Physical Therapy Direct Access and Health Insurance

  • October 12, 2018

As of July 2015, you can seek the care of a physical therapist WITHOUT a script or referral. Awesome news, right? Yes! You might have questions about how this might work with your insurance plan. Ah, insurance-always complicated.

The state of Georgia has restricted direct access, meaning people can see a physical therapist for treatment for a certain amount of visits/time frame without a patient requiring a referral with some restrictions on treatment/modalities allowed. That period is 8 visits or 21 days, whichever occurs FIRST. As far as treatment, the only restriction physical therapists have in the state of Georgia is a restriction on dry needling. Dry needling CANNOT be performed without a prescription from a physician (orthopedic, primary care, internal medicine, etc.)

If you have an insurance plan with physical therapy benefits, you probably would want to use it! Even if you have a high deductible plan, it is usually more cost effective for you to use your insurance with an in-network provider than it would be to pay cash for treatment.  Currently, *most* insurance plans, even HMO’s, do not require a referral/script for physical therapy in an outpatient or office setting. Authorizations might be required, but this is not the same as requiring a referral.

There are several benefits to not having to obtain a referral before starting physical therapy but one of the main benefits is that IT SAVES MONEY: for the patient, the insurance company, and the health care system. Direct access to physical therapy services can cut down on redundancy and unnecessary visits to other health care providers. For example, a person with minor or moderate aches and pains may go to an urgent care facility or their primary care physician. In many cases, they are referred to an orthopedic doctor. At that point, they might be referred to physical therapy IF they are not sent for imaging first (think MRI, which is often unnecessary and expensive.)  In some cases, they are also prescribed medication that often provides only short-term relief. In extreme cases, they have surgery that may not even be necessary.

Of course, MRI’s can be necessary as well as surgery for a certain populations or conditions. Physical therapists are ideal for treating post-surgical patients. However, physical therapists are EVEN BETTER at helping to prevent surgeries, diagnosing AND treating musculoskeletal conditions. The next time you have shoulder pain, back pain, knee pain, headaches, or any “nagging” issue that will not go away, contact a physical therapist!

*Our office will always verify your benefits. We also always highly recommend patients also verify their physical therapy benefits so they understand what THEIR plan covers and the details of THEIR plan. We are happy to review your benefits with you prior to initiating any treatment so that you have a good understanding of the cost of treatment.

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