We've recently had a number of patients inquire about the new laws regarding Direct Access v. Self-pay. Within the last couple of years, the law has changed for the State of Kansas concerning the necessity for a physician's prescription to begin physical therapy. 

Direct Access is the ability for a patient to be treated by a physical therapist for muscle or joint pain without a prescription written and signed by their referring physician (primary care or orthopedic), while still being able to use their insurance plan for payment as opposed to paying the entirety out-of-pocket.

Direct Access is not available to certain insurance plans, including some from Cigna and Humana- OrthoNet, as well as government-issued Medicare, or medicare replacement plans via a private company (such as Humana-Medicare, Coventry Advantra, etc.) For further information regarding whether or not your insurance allows for Direct Access, please call the customer service line noted on your insurance card. 

Direct Access is also not available at most physical therapy clinics for those patients who are beginning therapy on a body part immediately following a surgical procedure on said body part. Following operations, patients have a specific set of guidelines they are required to follow, including treatment precautions that must be abided by to heal properly.  Without operation notes from the procedure and a written prescription, physical therapists do not have access to the information necessary to treat a patient without significantly increasing the risks to the patient and liability of the treating therapist.

Self-Pay is the ability to pay for your own physical therapy visits under a number of circumstances:

  • When your insurance coverage has expired,
  • When you have already used your annual allotted physical therapy sessions pre-determined by your insurance company or specific insurance plans, 
  • When you need to save your allotted sessions for a pre-scheduled surgery later in the coverage period (many times Jan 1 - Dec 31).

For example: Some insurance plans only allow 25 or 40 covered physical therapy sessions per year. 

Self-pay still may require a prescription issued by the referring physician, dependent upon the insurance coverage a patient has. Again, for further information, contact your insurance company via the customer service line noted on your insurance card.