The Insurance Maze (Part 2)

by Jamie on October 22, 2012

What happens next???  In part that depends on with what company you end up pursuing therapy.  The backbone of the process should be the same wherever you go and will include the following steps.

Parent Step 3:  Complete the new patient paper work.  Different companies will ask for slightly different information but in general most will need the information listed below before proceeding.

  • Prescription/referral form from pediatrician
  • Completed case history form
  • Copy of insurance card
  • Copy of previous evaluations and/or plans of care

Parent Step 4:  Schedule an evaluation with the therapy company.

  • Be prepared to discuss concerns you may have about your child’s development with the therapist prior to the evaluation.
  • Plan on spending anywhere from 45 to 120 minutes at the appointment.
  • The data collected during the evaluation will include parental input, therapist observations and standardized testing.  Prepare your child by letting them know they will be asked some questions, shown some pictures, and/or asked to complete some simple tasks depending upon the type of evaluation done.
  • Schedule a time to speak with the therapist about the results of the evaluation.


Parent Step 5:  Wait for the therapy company to complete their part of the puzzle. Here are some of the things the company will need to do before beginning therapy.

  • Verify insurance coverage.
  • Score testing and evaluate data to determine therapy needs.
  • Write up evaluation results and plan of care.
  • Fax pediatrician for approval of plan of care.
  • Complete prior authorizations for insurance company.
  • Speak with parent about evaluation results and scheduling therapy (if needed).
  • Match patient with therapist that is qualified to address child’s needs and has availability.


Call if you need help 🙂 J

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