*Note: This article applies to the physical therapy laws in the state of New York.
Until recently, the process of seeing a physical therapist was like gaining access to highly classified government information. It was difficult.
Arbitrary regulations delayed patients from seeing physical therapists, leading to higher costs, decreased outcomes, and frustrated patients.
Since 2006, some of these barriers have been eliminated. New laws enable more timely and effective physical therapy care. Unfortunately, few people understand their physical therapy rights.
While many patients are referred to a physical therapist (PT), you do not need a referral to see a physical therapist in New York. This means, if you want to see a PT, you can make an appointment. You have what is legally termed, “Direct Access.”
What is Direct Access?
“Direct access” means you can call a PT and schedule an appointment. The Direct Access law was passed on November 23, 2006. As a result, you have the freedom to seek physical therapy treatment whenever and wherever you please.
According to the American Physical Therapy Association (APTA), in the state of New York:
Treatment can be rendered by a Licensed PT without a referral for 10 visits or 30 days, whichever comes first.
Licensed PT must have practiced PT on a full-time basis for no less than three years and be at least 21 years of age.
How does Direct Access work?
Direct Access is simple: you may visit a physical therapist when you choose.
During your initial visit, you will complete a physical evaluation and your PT will develop an individualized treatment plan for you. Physical therapists treat a wide-range of pain and injuries — balance and walking, neurological issues, sports injuries, diabetes and vascular conditions, age-related issues, and heart and lung disease — to name a few.
If additional tools like an X-ray or MRI are needed, your PT will communicate these requests to the physician of your choice. If your treatment extends beyond the 10 visits or 30 days (as outlined by the Direct Access law), your PT will also communicate this to your doctor.
Does insurance cover physical therapy via Direct Access?
Your coverage depends on your provider and health plan. Your insurance policy may still require a visit to your primary care physician, or limit your access to preferred providers.
According to the APTA, your physical therapist must provide written notification that PT services — provided without a referral — may not be covered by your health plan or insurer. It is important to note that Worker’s Compensation and Medicare do not participate in Direct Access.
Which physical therapist can you visit?
You have the freedom to choose your own PT. Since you can go directly to a PT without a physician’s referral, it’s your choice. If you visit your primary care physician first, he or she may refer you to a PT, but it is ultimately up to you.
Keep in mind that your insurance coverage may only cover expenses with preferred providers.
If you skip the referral process, can the physical therapist provide adequate treatment?
Given the traditional route to a physical therapist (i.e. primary care doctor, specialist, referral, PT), you may be concerned that by skipping the referral process, your PT might miss your underlying medical conditions. While this is an important consideration when visiting any healthcare provider, physical therapists have an extremely low rate of malpractice.
According to the APTA, “The rate of malpractice insurance has been shown to be no higher in states where physical therapists practice without a referral versus states where physical therapists practice with referral.”
Physical therapists truly care about your wellbeing. Every physical therapist in the state of New York is licensed. This means they have a master’s or higher degree in physical therapy and are well-prepared to diagnose your pain.
Bringing it all together
Physical therapists can treat injuries that may be the root cause of your pain. While many patients are referred to a physical therapist, you don’t need a referral to see a physical therapist in New York.
If you believe physical therapy is your best treatment option, Direct Access can save you time and money. Take advantage of Direct Access to avoid more costly and invasive solutions like surgery and expensive medication.
The Lattimore Physical Therapy & Sports Rehabilitation Network was founded by Physical Therapists John and Cindy Shuman in 1992. Since then Lattimore has grown to 20+ locations in 4 different counties.
What’s unique about Lattimore is our patient experience. We tailor your 1:1 treatment around your individual needs, conditions and goals. With us, you’re more than just a number. You’re a member of our local community and we’re invested in your success. Call 1–888-PT ROCHS to experience The Lattimore Way!
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