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Special Needs
S-Tuna
member
Question about paying for therapy
S-Tuna
member
We met with an OT today that we want to work with DS this summer. He'll be two in July. We expected to just pay her out of pocket, and on the phone she told me she charges $50/hr for self-pay. Today she asked about our insurance and said she has worked with them before. She told me to call them on Monday and ask if they will cover his therapy with her. She said they might not because she isn't with a clinic, but it is worth the call to ask. We are set to start with her on Tuesday. I told her we would pay cash until we figured out whether insurance would cover it or not. She told me to just wait on paying until they decide. I am terrible at insurance. I am clueless, and as much as I'm trying to understand it I'd rather just pay her $50 and not worry about the insurance part. We have a $50 co-pay for OT visits. It would be $50 either way, right? So, does it actually benefit me at all to pay through insurance?
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Re: Question about paying for therapy
Forgive me if you've been asked this before, but have you looked into Early Intervention to see if they will help cover it?
If not, I probably would go ahead and let her bill the insurance if she would get a better reimbursement that way. It sounds like she is giving a good deal to people whose insurance doesn't cover it at all (not sure how much ins would reimburse her; I know my son's OT was over $100/session) but maybe let her know how high your copay is and see what she says.
The only benefit I could see to going through insurance is that, presumably, the $50 per appt. would count toward the individual and/or family deductible -- and then it would at some point help offset other health costs somewhat, if it gets you closer to meeting your deductible.
That's another pisser about paying OOP, you can't even get it counted toward meeting your deductible. Check out the details of your plan, but don't discount that as a possible plus to having your insurance company involved!
DD1, 1/5/2008 ~~~ DD2, 3/17/2010
Our early intervention service coordinator and our social worker have both told us that there is nothing available to us right now. We are over income on any income-based assistance, and the programs that provide cost-share assistance gave us extremely high cost-share amounts. We have been fortunate enough to not have high medical costs until recently, but some help would be nice. We keep asking, but there is nothing I guess.
I will go through insurance if they will go for it. I want her to make more if she can (and I don't have to pay for it, lol). Auntie, I get the feeling that she likes doing OT as something to keep her busy now that her kids are grown. She has years of experience in school and clinic settings, and now she does therapy out of her home and in the community. I feel clueless when it comes to picking therapists. She seems like a good fit for us. I think. I hope.
One more question. Should I allow her to start therapy before we get the insurance all straightened out?
That stinks EI doesn't cover anything for you guys.
It's crazy how much it varies by state. Here in SC, they bill your insurance but then EI covers the rest. (Of course, in my son's case by the time everything got going he only got 6-12 weeks each of his 3 different therapies before he turned 3, but better than nothing!)
I agree that if she seems to be a good fit I'd go ahead and get started and get the billing stuff straightened out later.
I can relate. When we were in EI I didn't even think to investigate services privately, I just thought that EI would be the best option. Dumb.
In our state the amount you pay (after they bill your insurance) was on a sliding scale based on income. I probably could have saved us a boatload of money if I had pursued private services - but I was like a deer in headlights at the time.
I'd probably go ahead and get started with her and see how it goes. Pay her the 50 bucks and see what you can make happen w/ your insurance, if not oh well.
Thanks everyone.
If anyone knows the trick to winning the lottery, please share.
I recommend asking the OT what CPT code (procedure code) she uses when billing insurance. Then you can ask the insurance company if they even cover that procedure (ie, therapy). If they don't, then no matter what OT who have, the insurance won't cover it. But if they do cover it, then you may want to find an OT who is in network, especially if you see that this could be a long relationship (ie, many years of therapy).
And also important thing to find out from any therapist is what diagnosis code they are using when billing insurance. My insurance doesn't cover neurodevelopmental therapies (as many don't) but they do cover an services related to Autism. So if one our therapists uses the diagnosis code for Autism, the insurance will cover the service with no maximum number of visits.
Thanks for this. I have a lot to learn, lol. I will start asking these questions!
The cost is 50.00 out of pocket for you, continue to get treatment. Usually the therapist and insurance companies will work out their coverage with your child. Once they get back to you, the pricing may be 25.00/session if they cover the appointments, however insurance companies will not compensate you for sessions already paid out (usually).
When my insurance covered DS's OT last year, the cost out of pocket for us was $25.00/session, however patients without insurance cost 65.00+
Sadly, since February 2013 our insurance policy has changed, and they no longer cover OT - now we have to pay out of pocket.
OT treatments for us out of pocket are $50.00/session.