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Many insurance plans cover occupational therapy and physical therapy services but there may be certain conditions or limitations to coverage.
It is very important that you know what your plan will cover before your child begins therapy. Call your insurance company to find out what your plan will cover. If you have secondary health insurance (if another person in your household also has insurance), be sure to check coverage under that plan as well. Here are some questions to ask:
You are responsible for payment of therapy services if your insurance plan denies coverage. Insurance companies can deny payment for services even after they have authorized visits if they do not think the services are medically necessary. A quote of benefits does not guarantee coverage. The decision to pay for services is made by the insurance company when the claim is received and is based upon the insured person’s eligibility on the date of service.
It is very important that you fully understand your coverage and its limitations. For example, if your plan limits the number of visits, keep track of the number of completed visits to avoid higher out of pocket costs.
If you are unsure about whether your child’s therapy is covered, wait to schedule the appointments. Although you may schedule your child’s therapy prior to obtaining insurance authorization, you are responsible for payment if the sessions are not authorized.
If You Have a Therapy Benefit, But Coverage Is Denied
Discuss options for scheduling, which could decrease the cost of care, with your child’s therapist. Options may include scheduling sessions less frequently while increasing exercise/activity programs at home or utilizing community-based programs.
A member of the OT/PT Financial Services Team will contact your insurance company to verify your eligibility for therapy benefits, confirm if authorization or pre-certification are required, obtain necessary authorization, and assist you with questions regarding insurance coverage.
Our Financial Service Representatives can assist you with identifying financial assistance options. Examples include Cincinnati Children’s Financial Counselors (513-636-0201; PFC@cchmc.org) or Family Financial Advocates (513-803-6500; firstname.lastname@example.org), Bureau for Children with Medical Handicaps, or Hamilton County Developmental Disabilities Services.
You can contact an OT/PT Financial Service Representative at:
513-636-4651, option 2, or1-800-344-2462, ext. 4651, option 2
For further help or for answers to your questions regarding insurance coverage, contact our financial service representatives at:
Many insurance plans cover occupational and physical therapy services.
3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462 | TTY:1-513-636-4900
New to Cincinnati Children’s or live outside of the Tristate area? 1-877-881-8479
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