What is Direct Access?
Since January of 2015, people in Michigan can access the services of a physical therapist directly without a referral from their physician. This is called “direct access”. The current law allows for a patient to receive 10 visits over a 21 day period. From this point, if the patient has not progressed enough to continue on their own, then he or she would need to have a consult with their physician (MD, DO, podiatrist, or dentist) to continue. This represents a significant shift in how patients can access the services of a physical therapist but unfortunately only Priority Health has agreed to pay for services without a physician’s order. All other insurances still require a referral for the provider to receive payment. If you are willing to pay personally for your PT services, then you can access our help without the reimbursement problem.
If you are a Medicare patient, this law does not change the need for a physician to sign your plan of care (POC). As a result, it is better to start the referral process with you visiting your doctor first.
Over time, it is our hope a potential patient can access our services quickly and as needed with their insurance company’s support. You can help change this limitation by asking your HR department at work to request their insurance company to pay for PT services under the provisions of the direct access law or write your insurance company directly and voice your desire for them to acknowledge direct access.