Most people experience some sort of muscle and joint pain during the year and don’t know if they should see a physician or a PT first. Often pain can resolve on its own, but sometimes it lingers and is not gone in a couple of days, impacting your day to day life and requiring medical care. However navigating the health care system can be difficult. There are many different specialties, multiple settings (hospital vs urgent care vs outpatient facility). Insurance is frequently changing the amount of coverage you receive. And sometimes the wait to see a physician can be weeks or months. This process can drag out the time until you can start addressing the pain, further impacting your day to day. What’s a person to do?
Did you know that physical therapists (PTs) can operate as a first line of defense for people with muscle/joint pain, or other conditions treated by PTs such as pelvic-floor dysfunction, vertigo, and unsteadiness? Physical Therapists who have a direct access certification have the skills to triage patients and decide if their complaint warrants a doctors visit, urgent care, or if it is treatable by physical therapy. For example, if you have ankle pain after rolling your ankle, or nagging shoulder, knee, or back pain, that you are confident is joint pain, you can bypass an extra doctor’s visit and see a Physical Therapist first.
Wait What! What are the rules?
Physical therapy direct access rules are different state to state. For example, in Pennsylvania a PT is only allowed to see a client up to 30 days before the client is required to see a doctor and/or receive a referral from their Physician.
Many insurances do cover direct access PT, however payment for these services is contingent on the specific payer. Blue Cross Blue Shield insurance does not require a prescription or referral for PT treatment and payment, however Medicare requires a referral in order to pay for services. Check with your insurance company to see if they cover PT, or give our office a call and we can ask on your behalf. If your insurance requires a referral for payment and you prefer not to get one, you can always seek care from a physical therapy clinic using self-pay rates.
Whether you seek PT with a referral or not, in almost all cases, the PT will notify your physician and keep them in the loop regarding your care. Addressing your pain early on often leads to a quicker recovery. And most importantly, it can mean you getting back to everything you love. If you have any questions or concerns contact Action Potential Physical Therapy or consider scheduling an appointment to start your path to recovery today!