Is a Physical Therapy Referral Required?
Need a Physical Therapy Referral?
Maaaaaaaybe. (No. The answer is no. )
Like many things in healthcare, the answer to this question ought to be simple. But this is American healthcare we’re talking about, so buckle up…this might take a minute.
In Arizona (where we are located), a person seeking physical therapy services is NOT required to get a physician referral prior to receiving physical therapy. This is true no matter what insurance company you use. It is a state law. (The insurance companies who insure people in Arizona must comply).
Of course, if that was all there was to it, I wouldn’t have an entire article dedicated to this discussion.
For people who use Medicare: you are able to seek physical therapy without a referral. HOWEVER, within 30 days of beginning your treatment, your primary care provider will need to sign (a real signature, not a stamped one) a ‘plan of care’. This is a document that identifies your diagnoses and proposed treatment with your physical therapist. It also identifies the recommended frequency and length of time needed to successfully complete treatment. Some of primary care providers will require an office visit (with them) before they sign the plan. Others will not. It varies by provider. Also, a new and/or updated plan of care is required, by Medicare guidelines, every 90 days.
For people with other types of insurance: the process for approving and agreeing to pay for physical therapy is called ‘prior authorization’ or simply ‘authorization’. Each company has different time periods that they will agree to cover. (Some will agree to cover all recommended care from a physical therapist, some will only cover a few at a time and ask for regular updates on progress). Your out of pocket costs vary also, depending on your plan and insurer.
Now for the good news….your out of pocket costs are HSA (health savings accounts) eligible. All the documentation and prior authorization is handled by our staff. Your job in all of this is to follow the direction of our physical therapists – you will feel better, move better, and hurt less.
Check us out. You will be glad you did. Send us a message or give a call! https://physicaltherapytucson.com/contact-us/