Prescription vs. Referral

Being a physical therapist I may be biased but I think a profession that not only gives you the satisfaction of helping people plus the ability to tell them what to do every time you see them is unparallelled. I plan on giving insight into the field of physical therapy, into the outpatient setting and passing along a little wisdom on dealing with physicians, insurance companies, coaches, and all manner of related subjects.

First lesson: The difference between a Prescription and a Referral

Basically a prescription is written by your physician and is a tool used to request physical therapy services. It must have several elements A) a diagnosis, or what is wrong with you B) Frequency, how many times a week to come to therapy C) Duration, how many weeks to come to therapy D) Requested Services, I like evaluation and treat as indicated best, however, many surgeons have protocols that provide this information E) Date prescription was written F) Physician's Signature, yes, I know the nurse signed it but it's still a formality.

A Referral is issued by your primary care doctor depending on whether you have an insurance that requires one. Not all insurances require a referral. When you need a referral your primary care doctor is acting as a gatekeeper for health care and is deciding if you really need physical therapy, kidney dialysis, Neurosurgical Consultation, MRI, etcetera. Even if you have a prescription from a specialist such as an orthopaedic surgeon you may still need a referral to get care.

Now to make matters more confusing, your primary care doctor at least here in New Jersey can use the referral as a prescription for physical therapy. So what is the whole point of this explanatory blog? It is simply this; a prescription and a referral are two seperate things, usually. If you need a referral to go see a specialist, get blood work, etc., you will also need a referral for physical therapy services regardless of whether your specialist wrote you a prescription for physical therapy. So when the insurance specialist at your therapy provider asks whether you have a referral and prescription you'll know what they're talking about.

Oh, by the way, your primary care doctor is very busy and will usually take 3 days to process a referral so trying to call their office from the physical therapists office is futile. Just reschedule your physical therapy evaluation. It'll be less stress on everybody.