How Direct Access to Physical Therapy Works

Direct access to physical therapy means patients can be evaluated and treated by a physical therapist without needing a practitioner or other healthcare provider's referral. In other words, direct access lets you visit a physical therapist when you feel you need to see one.

This article will discuss what direct access is and how it is used for physical therapy services. It will also discuss how direct access differs depending on your health insurance plan and the state where you live.

What Is Direct Access?

Sometimes you may have back or knee pain because of an obvious injury like a sprain or a pulled muscle. Direct access gives you the power to decide if you need physical therapy. Sometimes direct access is called self-referral.

In the United States, each state controls physical therapy services through a "state-practice" act. The practice act is a law that says how physical therapy services can be delivered in that state. Each state lists different professionals who may refer patients to physical therapy, including podiatrists, dentists, and nurse practitioners.

The American Physical Therapy Association (APTA) has helped to change the law in many states to allow patients direct access to physical therapy. By having direct access, patients can see a physical therapist without needing a healthcare provider's prescription first. You can learn more about the kind of direct access your state allows by visiting the APTA's website.

Benefits of Direct Access Physical Therapy

Health care is expensive. It seems that with every passing year, more money is being spent on health care. A system that allows the patient to directly seek the services of a physical therapist can help save money by cutting out healthcare provider visits, unnecessary tests, and referrals to other specialists.

Many conditions can be successfully evaluated and treated with no expensive medical tests. Visiting your physical therapist directly allows you to start on treatment right away with very little risk of further injury. Physical therapy is a low-cost, value-packed healthcare service.​

Is Direct Access Safe?

Some people who don't agree with the idea of direct access to physical therapy services argue that patients may be put at risk if they visit a physical therapist on their own. Physical therapists lack the ability to order certain diagnostic tests or prescribe medication to help manage pain.

To date, there is no research showing that self-referral to physical therapy puts patients at increased risk. Also, there is no evidence that self-referred patients spend more on healthcare during or after their physical therapy care visits.

Physical therapists are also trained to spot "red flags" that may point to the need for more extensive medical treatment, such as surgery. In those cases, the physical therapist immediately refers you to your physician or healthcare provider.

Many states also have safety nets built into their practice acts. For instance, some states allow direct access only to therapists who have been practicing for three or more years.

Others allow a certain time frame or a specific number of physical therapy visits during an episode of care. If the patient requires skilled physical therapy after the time frame or number of visits is reached, the patient has to see a healthcare provider to continue treatment.

If you have a musculoskeletal condition that interferes with your ability to move without pain, use your best judgment when deciding which healthcare provider to see. A visit to your local physical therapist is a safe place to start on the road to recovery.

Who Can Self-Refer to PT?

How do you know if you can self-refer to physical therapy and get your health insurance to help pay for it? First, take a look at your health insurance policy. Here are some things you should check for:

• Check if your health insurance policy is a preferred provider organization (PPO) plan. A PPO has a list of preferred healthcare providers but allows you to choose one who isn't on the list. This type of plan also allows patients to self-refer. Unfortunately, it may require higher out-of-pocket costs, meaning you'll have to pay more on your own.
• Check if your health insurance policy is a point-of-service (POS) plan. A POS plan allows you to pay less for healthcare coverage if the healthcare provider is "in-network." This means that the healthcare provider accepts your health insurance plan. The downside is that POS plans usually require your primary care doctor to refer you to any specialist, including a physical therapist.
• Check if your health insurance policy is a health maintenance organization (HMO). If you have an HMO plan, you have to choose a primary care doctor within the network. Then the primary care doctor refers you to specialists. Although HMO plans are cheaper than other plans, you can't see a physical therapist without your healthcare provider's referral.

States With Direct Access Policies

Most states have policies about direct access and self-referral. In fact, direct access is available in some form in all 50 states, plus the District of Columbia. The rules differ depending on what state you live in.

You can check the APTA direct access map to see what rules, if any, your state has for direct access. If you are unsure if physical therapy is right for you, a discussion with your healthcare provider may be necessary to help you decide.

Summary

Direct access allows you to visit a physical therapist without waiting for a healthcare provider's referral. The level of access you have depends on your health insurance plan and the state where you live. Direct access may provide you with the opportunity to save both time and money since you don't have to see a healthcare provider first.