Do I Need to See My Doctor to Come to Physical Therapy?

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As of 2015, Michigan consumers have DIRECT ACCESS to physical therapy. This means that you are not required to have a physician’s referral in order to come to PT! You can come right in and ask for an evaluation for your injury or condition, and we can get you scheduled without a doctor’s visit or a prescription for therapy.

This can get tricky with insurances, however. In Michigan, Priority Health, United Healthcare, Aetna, and some Cofinity insurances will process claims without a doctor’s referral (prescription for therapy). Other insurances, like Blue Cross Blue Shield, Blue Care Network, Medicare, Priority Health-Medicare, and Medicaid, all require a prescription from your doctor.

So if you have Blue Cross Blue Shield and want to come straight to physical therapy, where does that leave you?

Often, if your doctor knows about your condition, you can call his or her office and request a prescription for PT to be faxed to our office without having to go in for a doctor’s visit.

If your doctor is unaware of your condition, he or she will likely want to see you before coming to therapy.

At this point you are welcome to either (1) start treatment at our self-pay rate, or (2) if you’d like it billed through insurance, you can come in for a free 15 minute consultation before you see your doctor. If you do this you can have a therapist evaluate your injury or condition and recommend if therapy would be a good option for you. If they believe we can help you here at Hudsonville PT, then you could go visit your doctor and get a prescription, after which we would officially start treatment.

The purpose of direct access is to alleviate cost by allowing quicker access to conservative care. Michigan was one of the last states to pass this law, and other states have shown that this model reduces the average cost of treatment and lends to improved outcomes.

Direct access is not as easy as it sounds because of the insurance rules surrounding it, but we work hard here to make physical therapy accessible to everyone.

Remember you can always stop in to set up a free, no-strings-attached consultation, and we are available to help answer your insurance questions the best we can!

​Call us at 616-662-0990 if you have questions about your insurance plan or would like to set up therapy! 

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Author: Lisa Bartz
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Sources:
apta.org

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