Getting Started with Physical Therapy

A referral is not always necessary. It is dependent on each specific insurance company/plan. Check to see if your state offers direct access state for physical therapy. This means that you can access physical therapy care without a referral. If you would like your insurance to pay for physical therapy services, it is important to contact your insurance company to determine if a referral is necessary for benefits to be paid out. If insurance is not available, you do not need a referral.

“Direct Access” means that legislation has been passed in your state to allow licensed physical therapists to evaluate and treat patients without first seeing a physician. As a “direct access” patient you do not need a prescription from your physician to receive out-patient physical therapy. However, many insurance plans do require you to have a prescription from your physician in order for outpatient physical therapy services to be covered and paid for by the insurance carrier.

As a “Direct Access” provider, physical therapists can truly provide direct access for diagnosis of, interventions for, and prevention of impairments, functional limitations and disabilities related to movement functionality. Physical therapists are experts in proficiently evaluating a patient’s musculoskeletal condition; and if appropriate, safely and effectively treating the patient. Physical therapists are highly-trained healthcare professionals, educated at the baccalaureate and post-baccalaureate level with extensive clinical training. Physical therapists have a proven track record of effectively treating millions of patients.

Physical therapists are also well-qualified to recognize when patients demonstrate conditions that should be evaluated by other healthcare professionals. We will suggest a referral to other health care professionals if necessary. In addition, with your permission, we will send our results to your physician and will work in conjunction with him/her.

To learn more about direct access and rules by state, please visit the official APTA Direct Access Web Page

For your first visit to physical therapy, be sure to bring the following items:

• Prescription for physical therapy from your referring physician if you have one
• X-rays, MRI or CAT scan report if you have it
• Government issued, photo ID (such as a driver’s license)
• Insurance card
• Patient forms, which can be downloaded from the patient portal and printed to be completed before the first office visit
• Patients who are minors (under 18 years old) must be accompanied by a parent or guardian for their first visit

During your first visit for physical or occupational therapy, your therapist will perform a thorough examination, in which he or she will review your physician’s recommendations, examine the problem area, ask you questions about your injury, develop an effective treatment plan for rehabilitation, discuss his or her findings with you, and answer any questions you may have. Your treatment plan will depend upon your diagnosis and will be customized specifically for you. Your treatment may include hands-on therapy, a customized exercise program, stretching, and physical agents such as heat, ice, ultrasound and electrical stimulation. Your physical therapist may also recommend a home program that you can do on your own to further assist in your treatment.

Your first appointment will typically last from 45 minutes to an hour or possibly an hour and a half, depending on your injury. Subsequent appointments usually take between 30 minutes and one hour, depending on the treatment.

The frequency of your treatment will depend upon your physician’s prescription and the plan of care developed by your physical therapist. Most patients require treatment two to three times per week. The duration of your treatment will depend upon your injury and your personal progress. Your physical therapist will discuss this with you following your initial exam, and subsequently as you progress.

A referral is not always necessary. It is dependent on each specific insurance company/plan. Check to see if your state offers direct access state for physical therapy. This means that you can access physical therapy care without a referral. If you would like your insurance to pay for physical therapy services, it is important to contact your insurance company to determine if a referral is necessary for benefits to be paid out. If insurance is not available, you do not need a referral.

If you are unable to attend an appointment, we require at least 24 hours' notice. However, we do understand that an occasional emergency or illness may arise, in which case you may have to cancel your appointment closer to your scheduled time.

In most cases, we will bill your insurance company for your treatments. If a deductible, co-pay, or co-insurance are part of your plan, payment is expected at the time of service. We also have very affordable cash pay programs. Please call your specific clinic for details.

We accept most major insurances including Medicare, Tricare and workers’ compensation plans. Before your first visit, we will verify in and out of network benefits with your insurance company. The cost of therapy is determined by the benefits of your insurance plan, including the deductible and co-pay, or patient percentage. We will be happy to check with your insurance company to determine the terms of your coverage and payment for patient responsibility is due at the time of service.

If you have a question regarding your medical claims or billed services, please call PRN directly at 1-800-929-4776 option 3. The billing service department will be able to answer any questions you may have.