Over the next few weeks, we’re going to start a series called “did you know?” Unfortunately, even though the majority of us have health insurance, we don’t really know what what it covers, especially when it comes to physical therapy. We’re going to discuss the problems that we are facing when it comes to dealing with insurance companies in physical therapy, the different types of models in physical therapy, and how you should go about finding out what your benefits and access to PT are.
We’ve partnered up with our good friends Inside Out Physical Therapy and owner Dr. Dave Paczkowski to shed some light on why it’s important to know all your options when dealing with an injury or trying to prevent one from occurring. This week we are going to cover direct access to physical therapy. Never heard of it or are unaware of what it is? Let’s dive into the first part of our series!
What Is Direct Access?
In New York and in the majority of states here in the US, you have the option to see a physical therapist without needing a referral from a doctor. Let me repeat that. YOU have the option to see a physical therapist WITHOUT needing a referral. Many people that I come in contact with think that they need to be sent to physical therapy by a physician. A physical therapist can assess, diagnose, and determine further course of treatment depending on the condition. We also have the knowledge and skill set to refer to another provider should you need further testing or other care that might be out of our scope of practice.
Old School vs. New School
I’ll give you a pretty typical example as to how people normally go about dealing with any discomfort or injury they are experiencing:
- Client A injures their back playing a pickup basketball game.
- Client A waits a week or two to see if pain goes away.
- After a week or two, the pain doesn’t go away, so they make an appointment with their primary care physician.
- The physician tells Client A to rest longer and take medication if need be, and they might do an x-ray to rule out any significant injuries.
- After a few weeks of rest and medication, Client A’s pain is about the same. Client A returns to their primary care physician, who then refers them to see an orthopedic specialist.
- After waiting a few more weeks, Client A finally sees the orthopedic physician and they either determine that surgery is not needed, that an injection could be beneficial, or they might recommend getting an MRI.
- Client A opts for the MRI, which shows nothing to be alarmed about, so the orthopedic then refers Client A to try physical therapy.
By this example is over, it’s usually 2-3 months from when the initial injury occurred. If Client A knew that he could contact a physical therapist and be seen for his low back pain right away, there’s a good chance he could’ve avoided having to wait longer to finally get some sort of resolution to his discomfort.
- New York allows a licensed physical therapist to see a person for 10 visits or 30 days, whichever comes first. You do NOT need a referral from a physician.
- If a physician makes a recommendation as to which physical therapy you should see, do your research. You have every right to look for a different physical therapy provider if you feel there are better alternatives.
- Knowledge is power when it comes to making decisions about your health. The more you know about what your options are, the better you can make a decision. From there, you can seek the best provider based on your needs to get your discomfort or condition under control.
Do you have any further questions about how you can access care by a physical therapist? Feel free to reach out to us and let us help you find a resolution to whatever you are dealing with! Stay tuned for more on these topics next week!