Physical therapists in California are now able to treat patients without a physician referral through the direct access process.
Direct access impacts your own care, because the ability to receive prompt physical therapy services without delay allows for an expedited, well-planned recovery.
When does direct access come in handy? Just think about all the potential situations that require immediate guidance and care from a physical therapist. Perhaps you develop pain that interferes with your daily activities. Or maybe you need rehabilitation from an injury or surgery. Having immediate access to a physical therapist (a licensed health-care provider who helps restore your physical function) dramatically improves the recovery process.
Through the direct access process, you can pursue physical therapy directly for up to 12 visits or 45 days, whichever occurs first. After that time, a physical therapist must refer you to a physician, osteopath or podiatrist for a signed approval on the physical therapist’s plan of care.
When you visit a physical therapist, he or she will document the history of your condition and examine strength, range of motion, balance, posture, flexibility, coordination, endurance and overall mobility. Your therapist will then design a treatment plan based on the findings and your goals.
The initial goal is usually to reduce any pain or swelling. Manual techniques, education and specific guided exercises will be integrated to help restore function as needed. The biggest benefit of successful physical therapy is attaining a pain-free existence and eliminating the need for surgical intervention or long-term pain medications. The sooner you act to resolve your physical problem, the better your chance of full recovery.
Direct access and insurance
Many patients wonder how their insurance benefits are impacted by direct access. The best recommendation is to contact your insurance provider to determine your direct access coverage. In many cases, insurance companies are readily reimbursing for direct access care due to the cost savings of expedited treatment.
However, if you choose to use your health insurance to help finance your direct access therapy, you may encounter varied coverage, depending on your chosen provider. Most PPO insurance plans allow some amount of coverage regardless of where you seek treatment. But some of the newer narrow network and California Care PPO plans have more limitations in access.
It is also important to know that if you have an HMO, you will not have coverage if the physical therapy provider does not have a contract with that plan.
Regardless of your insurance plan, you always reserve the right to go where you choose without using your insurance benefits. You may also choose any physical therapist regardless of a referral on a prescription.
Selecting a clinic
So what should you look for in a physical therapy clinic? Inquire about time spent directly with the licensed physical therapist versus support staff assisting in patient care. Ask how long the licensed physical therapist would spend with you rather than the length of the appointment. Most physical therapy clinics have similar time blocks for the entire visit, but the one-on-one time with a licensed therapist varies from place to place. You should also inquire about the qualifications of the therapist treating you.
In pursuing direct access to physical therapy, what is most important is that you choose an experienced, licensed professional who is instinctively right for your needs. When you have pain that affects your ability to enjoy life, it is well worth your time to connect immediately with a provider who can guide you to a successful recovery.
Kim Gladfelter is owner, physical therapist and Pilates instructor at PhysioFit Physical Therapy and Wellness, 1000 Fremont Ave., Los Altos. For more information, call 947-8500 or visit physiofitpt.com.