How do I benefit from Direct Access?

Direct Access provides you with immediate and economical access to physical therapy services. In a study conducted to determine whether direct access to physical therapy services is cost effective, it was found ^[1] that:

• The total paid claims for physician referral episodes to physical therapists was 123% or 2.2 times higher than the paid claims for Direct Access episodes. (The total paid claims averaged $2,236 for “physician referral” episodes as compared to $1,004 for Direct Access episodes.)
• Physician referral episodes were 65% longer in duration than Direct Access episodes.
• Physician referral episodes generated 67% more physical therapy claims and 60% more office visits than Direct Access episodes.

Will insurance cover my visits?

When comparing in-network and out-of-network physical therapy benefits, patients can typically expect to pay between $10–$50 dollars more per visit, depending on the insurance company.   Patients work with their physical therapist in a one on one treatment session, compared to larger practices where patients are seen by assistants, techs, and aids. Frequency of visits is also tends to be less, which eases impact on patient schedules. Research has shown that being seen in a practice like PTC Physical Therapy, is more cost effective for the patient, and that recovery is faster.

You should note, at this time Medicare holders are not able to participate in Direct Access. Most health insurance companies have unique requirements pertaining to physical therapy coverage. Some require policy holders to have a referral from a physician in order to seek reimbursement. We highly recommend that you contact your insurance to confirm your physical therapy and out of network provider benefits. Because PTC Physical Therapy may  be considered an out-of-network provider in some cases, you are responsible for all charges at the time of service. Your physical therapist will provide you with electronic copies of your initial evaluation and subsequent follow up treatments, plus necessary paperwork to submit to your individual insurance company to seek reimbursement.

What if I need a physician in addition to physical therapy?

We believe in the importance of collaboration between your chosen primary care practitioner and the rest of your health and wellness team. Therefore if you don’t have a primary care provider, we will refer you to a physician if  your physical therapist determines that your condition requires a physician’s evaluation.

[1] Mitchell, Jean M. and de Lissovoy, Gregory. Research Report: A Comparison of Resource Use and Cost in Direct Access Versus Physician Referral Episodes of Physical Therapy. Physical Therapy, 77, January 1997.