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I read on https://www.ccapta.org/mpage/MoveInsurance (mirror):

Physical therapist services may be obtained without a physician’s referral if you are a cash carrying patient, receiving treatment for up to 45 calendar days/12 visits, receiving health and wellness services, or if you are a UnitedHealthCare or Medicare beneficiary. Please note: some health insurance companies require a referral in order for your provider to be paid.

What is a "cash carrying patient"? Does it mean that the patient pays the medical provider without going through any health insurance?

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It looks like this is the term they're using to describe customers that pay in cash.

Generally speaking, limits and approvals and referrals are a requirement of an insurer not a provider. If you have a diagnosis your physician may refer you in to a physical therapist and your insurer may approve 10 sessions. Your insurer also required you to be referred in to the physical therapist by your physician.

This physical therapist is saying you don't need any of that if you want to come and pay cash. They're beating around the bush a little, but they're saying, there's nothing stopping you from making your own appointment to see a physical therapist about a kink in your neck. But they are saying, if you refer yourself in, your insurer likely won't pay and that is not their problem.

  • Thank you, got it, so just to confirm: pay in cash = pay the medical provider without going through any health insurance? – Franck Dernoncourt Feb 24 at 21:48
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    @FranckDernoncourt, correct. Insurers have a process in place, if you go outside their process and procure treatment, even if it would otherwise be covered, they won't pay. Is it possible that you could submit these bills after the fact and have an insurer cover or minimally apply these amounts to your deductible, maybe. But this physical therapist is taking the position that if you refer yourself in to pay cash, we'll take you, but your insurance carrier likely won't pay, and that's your problem. – quid Feb 24 at 21:52
  • Interesting, it sounds like the most upvoted answer in Does paying a medical provider in cash count toward one's insurance deductible? say that the money spent as a cash carrying patient (= paid the medical provider without going through any health insurance?) counts toward the deductible, which would contradict your comment. I don't know what is true. – Franck Dernoncourt Feb 25 at 2:41
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    @FranckDernoncourt The core issue when dealing with an insurer is "allowed amount" toward "covered services." If you walk in to a physical therapist's office with no physician referral most US insurers would not consider your visit to be a "covered service" making the "allowed amount" zero. You can certainly send the bill in, but it's really unlikely to be covered or apply to deductibles. This physical therapist is saying, that's "Great, come in and pay cash. If you come in with no referral, adjudicating your claim with your insurer is your problem, not ours." – quid Feb 25 at 3:04

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