Answering the Age Old Question: Do I Need a Doctor’s Order From a Medical Provider to Start Physical Therapy?

That’s a great question!

You have probably heard that Minnesota has what is called “Direct Access” to a Physical Therapist. This is good news but can also be really confusing.

Let’s clear up some of that confusion!

Although Minnesota is an Open Access state, that doesn’t necessarily mean that a doctor’s order is not required. Every insurance plan has its own specifications that providers and you, the insured, must follow. Since every insurance provider is different and has multiple plans, our billing department proactively checks all insurance coverage prior to your evaluation to make sure that we have everything we need so you can continue your treatment as planned.

Here is a list of plans that we have verified require a doctor’s order for physical therapy:

Medicare
All Medicare Replacement plans
All Veterans Administered plans
Blue Cross Union plans
All Medica plans
All Ucare plans
Medical Assistance
All Workers Compensation
Primary Care Clinic (PCC) plans for all insurance carriers

What health care professionals can provide you with a doctor’s order for physical therapy?

Any Medical Doctor (MD), Physician Assistant (PA-C), Nurse Practioner (CNP), Chiropractor, or Dentist can provide your with a doctor’s order to physical therapy. The only exceptions are for VA and PCC plans. VA plans are strictly MD only and PCC plans need the referral to be from your chosen primary care clinic.

So what can you do to be sure that you and your Physical Therapy provider of choice have everything needed to get started with physical therapy with or without a doctor’s order?

There are a couple ways you can verify your insurance coverage:

1. Directly call your insurance provider and ask them about outpatient coverage at a Physical Therapy Consultants, Inc location of your choice.
   
   Here are some questions to ask to get you started:
   Do I need a doctor’s order for physical therapy?
   Will I have a copay?
   What is my deductible and co-insurance?
   Do I have a visit limit?
   
2. When calling to schedule your initial evaluation, provide the front desk specialist with your insurance information including type, group number and ID number. Be sure to specify during that call if your plan is related to worker’s compensation or an auto injury claim.
   
3. Call our billing department directly at 763-269-8065. Let them know that you are wanting to determine coverage for physical therapy services at a Physical Therapy Consultants, Inc. location of your choice. Provide our billing specialist with insurance information including type, group number and ID number. Be sure to specify during that call if your plan is related to worker’s compensation or an auto injury claim. Our billing specialists will also be asking similar questions to your insurance carrier upon scheduling your initial evaluation. This process is completed before your first appointment. Our team of experts will do their best to get the most accurate information related to your insurance coverage however it is important for you, the insured, to know your responsibility related to
   your care and your insurance coverage.
   
   We hope this helps to clear up any confusion related to your care. Be sure to reach out to our billing department directly at 763-269-8065 with questions related to your insurance coverage.
   
   We are happy to help get you started on the right path in your physical therapy journey!
   
   Written by Megan Rasmussen, Billing Specialist and Jackie Giese, Director of Marketing

PTC_therapy October 17th, 2019

Posted In: General