Direct Access to Physical Therapy

By April Mettler

Direct Access/Direct Reimbursement: Implications and Your Right to Choose

CC’s Physical Therapy has been an independent medical office since its birth in 2011. Many times, people ask us, “where do all your patients come from?” Most of the time, the answer is simple: they pick up the phone. In 1989, the state of North Dakota adopted direct access for all physical therapy services. This means that physical therapists can assess and treat patients within our scope of practice without any form of a doctor’s referral. The other half is direct reimbursement. Although we have direct access, not all insurance carriers allow direct reimbursement. Payers such as Medicare, Tricare, TriWest, and various other individual commercial health plans require the doctor’s referral for the provider to stay compliant and ensure insurance reimburses for the serves rendered. BCBS (most states), UHC, and Sanford are examples of insurance companies that have direct reimbursement. When combined with direct access, you can pick up the phone without a referral and call to make an appointment with your physical therapist today!
If you are one of the individual’s that are required to secure a prescription prior to being evaluated by a physical therapist, here is what you need to know. 

  • 1. As a patient and consumer, it is 100% YOUR choice to select YOUR health care providers. Every person has preferences on all your healthcare providers; maybe it’s their physical location, their office hours, you want to see a family friend of yours, or maybe you have heard excellent reviews about a therapist in Carpio, ND. Whatever the reason it, is your choice. We choose our dentist, our optometrist, our primary care doctors, our pediatricians; physical therapy is no different. All physical therapists are trained to treat musculoskeletal impairments, post op care, acute to chronic pain or injury, and many other dysfunctions (conditions treated). It is OUR job as ethically trained Doctors of Physical Therapy to determine if the condition is a) appropriate for physical therapy, b) needs further evaluation by a physician, or c) would be better served by a different profession or a different PT more specialized in the present condition.
    2. Often, your doctor may require you to schedule an office visit. Do not let this deter you from completing the process! A simple office visit with your physician sometimes is required where your provider will screen for other conditions while also confirming or evaluating your desire to seek treatment by a PT. If your health care provider also agrees that physical therapy would be an appropriate treatment, the provider can simply fax the referral to the facility you wish to go to. Just know at that time, you can select your provider you are desiring.
    3. Physicians are not the only ones that can write a prescription for physical therapy. If you see a nurse practitioner or physician assistant, they too can prescribe or refer to physical therapy.
    4. If you have questions, ASK! Healthcare and health insurance are incredibly complicated entities, unfortunately. That’s why here at CC’s we are dedicated to answering insurance questions and verifying your benefits; this helps our patients understand their benefits specific to your insurance policy, rather than generalizing physical therapy benefits or guessing. When we verify your benefits, we will know immediately if a doctor’s referral is required and can help guide you through the process.

Always remember, when it comes to your healthcare, it is your body. Never do anything that makes you feel uncomfortable. Find a provider in all realms that suits your needs, beliefs, and desired outcomes. It can be a lengthy process to find providers in sync with you and your family, but trust me there is someone for everyone.

Post Author: April Mettler

Hot mess express entrepreneur that has trouble submitting blog posts on time. (says Selma)


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