Insurance and therapy
Before your visit, we strongly encourage you to contact your insurance company directly to ask specifically which outpatient physicians and services will be covered during your visit(s). If services are not covered by insurance, the hospital asks for payment on the day of the appointment.Visit the Billing section of our site for more general information.
For example, your insurance plan may:
- Require a physician's order for treatment
- Require pre-authorization before treatment can begin
- Require a referral from your primary care provider
- Limit the number of annual visits
- Limit the dollar amount paid toward annual services
Common reasons insurance companies may offer for not covering physical or occupational therapy services are that your child's “therapy…”
- Is maintenance therapy
- Is for development delay
- Is not medically necessary
- Is only covered for treatment that is “restorative” (i.e., if skills were lost because of illness, accident or injury)
- Must result in significant improvement within a certain time frame
- Has used your plan's entire benefit for the calendar year
- Duplication of services (receiving services elsewhere)
Suggestions for families dealing with insurance issues:
- Act as the liaison between the insurance company and your child's therapist or physician
- Keep a log of all insurance calls, including the names of the individuals you speak with
- Keep copies of all letters from your insurance company
- Ask to speak with our insurance coordinator
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