Therapydia DC works with and provides billing for most PPO insurance groups including Aetna and Blue Cross Blue Shield / CareFirst. For clients with out-of-network benefits, most PPO’s will pay a portion of treatment charges with a prescription from a physician. Payment is expected at the time of service. We will assist you in submitting a superbill to your insurance and you will receive reimbursement directly from them. Contact us to find out your coverage options.
In some states, patients cannot receive treatment from a physical therapist without a prescription or referral of a physician according to state law. This requirement doesn’t acknowledge the extensive training, education and expertise of the licensed physical therapist and it limits the rights of patients.
However, many other states, including Washington DC, allow direct access to physical therapy services or “self referral”. This allows patients to be evaluated and treated by a licensed physical therapist without first seeing a physician for a prescription. Direct access saves time and money, thus expediting your treatment, relief, and recovery.
Direct Access is described in depth by the American Physical Therapy Association as follows:
What does patient access to physical therapists’ services without referral mean and why is it needed?
Patient access to physical therapists’ services without referral means the removal of the physician referral mandated by state law to access physical therapists’ services. Thirty-eight (38) states have granted consumers the freedom to seek physical therapy treatment without a referral. Currently, a referral is required by state law to initiate treatment by a licensed physical therapist in 12 states.
Are physical therapists qualified to deliver physical therapists’ services independent of referral?
Absolutely. Physical therapists are educated at the post-baccalaureate level and receive extensive education and clinical training in the examination, evaluation, diagnosis, prognosis, and intervention of patient/clients with functional limitations, impairments and disabilities. Beginning January 1, 2002 all physical therapy programs will be required to be accredited at the masters level. Physical therapists are qualified to recognize when a patient presents with signs and symptoms inconsistent or outside the scope and expertise of the physical therapist and when the patient should be referred to a physician. APTA’s Guide of Professional Conduct advocates that physical therapists should assist patients in receiving appropriate medical care when the physical therapists’ examination and evaluation reveals signs and symptoms inconsistent with a condition that can be appropriately treated with physical therapy or needs a physician’s care and expertise.
Liability insurers and the Federation of State Boards of Physical Therapy affirm that physical therapists’ services provided without referral does not jeopardize the health, safety, or welfare of the patient/clients seeking physical therapists’ care and services without referral. Health Providers Service Organization (HPSO), the leading liability insurer of physical therapists in the United States, states in a March 22, 2001 letter, “that direct access is not a risk factor that we specifically screen for in our program because it has not negatively impacted our claims experience in any way. In addition, we do not have a premium differential for physical therapists in direct access states.”