What You Can Do If Your Provider Is Hesitant To Refer to Pelvic Floor PT During Pregnancy
A few times a week, we get a call from a patient who is having a hard time getting a referral from their provider for physical therapy during pregnancy. They’re often confused by why they need a referral, why they’re struggling to get a referral, and why an out of network clinic requires a referral. In this blog post, we’re going to answer all of these questions and guide you through three steps you can take to get the care you need during pregnancy if your provider is hesitant to refer to pelvic floor physical therapy.
What is a referral?
First things first, it’s important to understand what a referral is and isn’t. A referral is a document created by your medical provider that states that they’re sending you, their patient, to physical therapy. It’s essentially an authorization for physical therapy.
A referral has to include the patient name and what they’re being referred for and the name of the provider referring to physical therapy. They also can, but are not required, to include how many visits the patient is being referred for as well as who they’re being referred to.
A referral can come from a medical doctor (MD), osteopathic doctor (DO), certified nurse midwife (CNM), nurse practitioners (NP), physician assistant (PAs), or chiropractor (DC).
Why does an out of network clinic require a referral?
It’s a common misconception that referrals are a requirement of insurance companies, but that’s not the case. The Executive Council of Physical Therapy and Occupational Therapy Examiners outlines the requirement for physical therapists in Texas to have a referral within 10-15 business days of evaluating a patient. This is not an insurance requirement - it’s a requirement of the Texas PT license and practicing beyond that timeline without a referral means a physical therapist is practicing outside the bounds of their licensure.
With that said, having diagnosis codes from your medical provider may improve out of network reimbursement.
Direct access physical therapy in Texas
Direct access physical therapy means being able to access physical therapy care without a referral from your provider. Direct access rules vary from state to state, with some states allowing for treatment by a physical therapist for up to 2 months without a referral for PT and other states, like Texas, requiring a referral within 10-15 business days.
So what does this mean for Texans?
In the state of Texas, you can schedule an appointment with a pelvic floor physical therapist without asking your provider for a referral. You can come in for your first appointment and be evaluated and treated without a referral, and you can continue to be seen for up to 10-15 business days without a referral. 10 days is the standard amount of time you can work with a physical therapist without a referral, but if your physical therapy did a residency program or has an advanced certificate, this extends to 15 days, depending on clinic policy.
If you and your pelvic floor PT intend to continue working together beyond 10-15 days, which is a reasonable expectation during pregnancy, you will be required to get a referral from your provider to continue treatment.
Why are providers hesitant to refer to pelvic floor PT during pregnancy?
Providers have their patients’ best interests at heart, and most providers are cautious creatures of habit. MDs and PTs alike often fear what they don’t know and hesitate to encourage patients to take advantage of services they don’t understand. Your provider has your best interest in mind, but may be hesitant to refer for a number of reasons.
A common reason providers don’t feel comfortable referring to pelvic floor PT is if they believe every visit includes a pelvic exam or that pelvic exams are all pelvic floor PT has to offer. If you’re not cleared for a pelvic exam for whatever reason, be that a shortened cervix or a result of being in the early postpartum recovery weeks, your provider may be hesitant to refer to PT because you’re not cleared for the exam. In a case like this, they may think a PT visit is unsafe or that there’s no point.
Pelvic floor physical therapists evaluate and treat from head to toe and the pelvic exam is just one part of the full picture. If this is the case, it can be beneficial for your PT to call your provider and explain what a treatment session looks like and treatment options that do not include a pelvic exam.
Another common reason your provider may be hesitant to refer to PT is because they don’t understand your goals. Historically, pelvic floor PT has been used primarily to help people recover from birth. As both research and the field progress, we’ve uncovered a number of benefits to seeking care prenatally. These benefits include reduced risk of cesarean, reduced severity of perineal tearing, improved pushing efficacy and reduced leakage, pain and weakness before and after birth.
Because prenatal pelvic floor PT is a relatively recent concept, your provider may be unfamiliar with the benefits of prenatal pelvic floor PT care and unfamiliar with how this care can help you work towards whatever goals you have. In this case, explaining why you want to seek care can make a big difference.
Three steps you can take to if your provider is hesitant to refer to pelvic floor PT
It’s always uncomfortable when you’re requesting a type of treatment that your provider doesn’t enthusiastically condone. The power dynamics of provider vs patient make it challenging to advocate for yourself and this can leave patients feeling unheard if not prepared for these challenging conversations.
It shouldn’t be this way. Healthcare should be about collaboration between patient and provider with ego left at the door. But how things should be and how things are do not always align. Understanding your providers hesitancy and navigating conversations like these openly and directly is key to maintaining a healthy and open relationship with your provider.
If you request a referral to pelvic floor physical therapy and your provider hesitates, here are three steps you can take to ensure you get the care you need during pregnancy:
Ask them why: This is an incredibly important first step. You need to ask why they’re hesitant. There are cases where physical therapy is not appropriate. These cases can be a result of the cause of pain or symptoms being outside of the PT scope. In other cases, folks are not medically cleared to participate in PT as a result of a medical condition or complication. Understanding whether your providers hesitation is a result of a medical contraindication is key to navigating this situation safely. Once you understand why they’re hesitant, assuming no medical contraindications at play, you can move on the explaining your goals.
Explain your goals: Once you’ve determined that there’s no medical contraindication for pelvic floor PT, you can move on to step two. Your provider may be unfamiliar with why you’re interested in seeking pelvic floor PT during pregnancy. They may be unfamiliar with the fact that symptoms can, and should, be treated during pregnancy instead of waiting for them to spontaneously resolve postpartum. They may be unfamiliar with the fact that you can train your pelvic floor and body for birth and prepare your body for postpartum recovery to reduce the likelihood of symptoms and injury following birth. Explaining why you want to seek care during pregnancy can help. Explaining your goals and the potential benefits you seek can make a huge difference for provider buy in.
Get evaluated by a pelvic floor PT and have them contact your provider: If your provider requires more information to provide you with a referral and there’s no medical contraindication, call your favorite pelvic floor PT clinic and schedule your initial evaluation. Let your physical therapist know at your first visit that you need them to contact your provider to explain their exam findings and plan for treatment. My personal experience as a PT has demonstrated that 9.5/10 times, this works like a charm. Your provider wants you to get help and feel supported. Sometimes they just need a little help understanding why you’re seeking the care you’re seeking. This communication between pelvic floor PT and your provider opens a productive channel of communication, allowing them to better work together to support you throughout pregnancy and recovery.
One thing every pregnant person should know
If you’re experiencing pelvic floor symptoms during pregnancy, they can and should be treated during pregnancy. While some symptoms do improve following childbirth, symptoms like urinary incontinence, prolapse, pubic symphysis or back pain tend to get worse as pregnancy progresses. Additionally, experiencing these symptoms during pregnancy increases the risk of them continuing postpartum. Seeking treatment when these symptoms start help reduce the risk you’ll continue dealing with these after birth.
If you have questions about how pelvic floor PT works or how we can help, send us a message here.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.