Insurance Coverage for Therapy Services
Know What Your Insurance Covers
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:
- Does my plan provide coverage for occupational therapy and/or physical therapy?
- Does my plan provide coverage for occupational therapy and/or physical therapy provided in a hospital setting? Cincinnati Children’s therapy services are billed as an outpatient hospital service – there are some insurance plans that provide different levels of coverage for therapy billed as an outpatient hospital service than for those billed as an office visit.
- How many visits are allowed under my insurance plan?
- If my child needs several therapies such as OT, PT, and Speech, will the same number of visits be allowed for each?
- Are there any exclusions or limitations to therapy coverage?
- For example, some insurance plans will not cover services for children diagnosed with developmental delay
- Some payers (Tricare, for example) require a new physician referral for therapy services every 12 months
- Some payers (many Humana plans, for example) will cover an initial therapy evaluation but will not cover ongoing treatment services until they have reviewed the plan of care and authorized a number of visits
- How much will I be expected to pay out of pocket? Examples of out of pocket costs include co-payments which are due at each visit for each therapy service, any unmet deductibles, and any co-insurance amounts.
