The Insurance Maze

by Jamie on October 17, 2012

My child needs therapy.  Do you take my insurance???

We get this phone call multiple times a week from parents who are new to the therapy world and do not know where to start.  Usually our answer begins with….”Well, it depends.”  Sometimes we can answer all of the important questions with a quick on-line insurance search and a 5 minute phone call with mom or dad.  Sometimes the process is more complicated and time consuming for the parent.  If you are trying to navigate the maze of private insurance, check in with us over the next two weeks and we will give you some tips that might keep you from getting stuck in a dead end.

 

Parent Step 1:  Call your insurance company.  Get a representative on the phone and ask about your policy.  We suggest starting with the following questions.

Coverage

  • Does my insurance policy cover speech/occupational/physical therapy?
  • If so, for what diagnoses or under what circumstance is therapy covered?
  • Is there a limit to the number of therapy visits that my child can receive?
  • Does therapy require prior-authorization from your clinical department?
  • Does my policy cover out-of-network providers?
  • Do you have a list of local in-network providers?

Cost

  • Do I have a deductible that I have to meet before the insurance will cover therapy?
  • What part of the cost is covered by insurance for in-network providers?
  • What part of the cost is covered by insurance for out-of-network providers?
  • Do I have a different deductible for out-of-network providers?

 

Parent Step 2:  Find a therapy company that meets your needs.  Call or email the owner/therapist.  We suggest you consider the following:

  • Is the therapy company conveniently located?
  • Are they professional, qualified, helpful and responsive?
  • Do they take my insurance?
  • Does the company have immediate availability?  How long is the wait list?
  • If my insurance does not cover the cost of therapy, is the contracted rate or private pay rate reasonable?

Feel free to check in with us if you need help interpreting the insurance information or get stuck in a dead end.  Come back to visit our blog next week for a guide to “what happens next” in the process!!

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