When your child needs speech or occupational therapy, “good enough” isn’t good enough. You want a provider that can truly work with your child to identify and address everything expertly and professionally. You need someone like Basal. There’s one more obstacle many families likely face, however: insurance. You have no idea how to get insurance to pay for occupational therapy (or any therapy, for that matter). So how do you go about the whole process? Here are a few insurance tips.
Understanding Basal Therapies’ Provider Status
First off, you should take some time to get to know us. What do we do? We’re an outpatient provider offering therapy services for children. From an insurance standpoint, we’re considered a specialty provider for habilitative speech and occupational therapy.
It’s this distinction that has a big impact most families aren’t aware of. There have been cases of insurance representatives mistakenly quoting rehabilitative benefits instead of habilitative benefits. For the potential patients and their families, this can cause a confusing situation when they receive information that isn’t correct.
When speaking with any representative regarding insurance coverage, make sure they understand the type of care you are seeking.
How Insurance Misclassification Can Impact Coverage
Unfortunately a misclassification doesn’t stop at providing bad information; it can affect visit limits, coverage eligibility, and claim processing. Why? Because these two classifications refer to entirely different circumstances with their own rules and guidelines.
- Habilitative Therapy: Helps individuals develop new skills
- Rehabilitative Therapy: Helps individuals regain skills they previously had (think of the physical rehabilitation one must go through following a serious injury)
We know these first two insurance tips have been similar, but an in-depth explanation was needed to stress the importance of making sure the therapy is properly classified with your insurance company. If something goes wrong here, it can cause countless headaches.
Key Insurance Call-Tips Every Family Should Follow
Once you’re ready to make the call to your insurance company, make sure you get vital information that’s important to have through the process. When the call begins, ask for:
- A call reference number
- The name of the representative
- The department they work in
Keeping this information on hand will help you track conflicting information and support your claim appeals. Additionally, it will allow us (Basal Therapies) to step in and provide assistance should your claim be denied.
The Importance of Tracking Your Explanation of Benefits (EOBs)
Keep track of your Explanation of Benefits (EOB)! Rather than a bill, it’s a summary of the way in which your insurance provider processed the claim you made. Reviewing such summaries can help you catch issues should any arise throughout your experience. In particular, families should look for correct provider classification, accurate visit counts, and proper service processing.
Almost every online insurance portal offers easy access to EOBs, so take advantage of this feature to ensure potential errors are addressed sooner than later.
Essential Insurance Questions to Ask Before Starting Therapy
There are some crucial inquiries you should be making before your child begins therapy.
Deductibles
- Does your plan require a deductible?
- How do therapy costs apply before and after the deductible is met?
- What happens when the deductible resets?
Copay vs. Coinsurance
It’s vital to understand the difference between these. This article from MetLife explains it thoroughly. Depending on your circumstances, you could owe a copay, coinsurance, or both in some cases. Regardless, it helps to know the details beforehand so you can avoid unexpected expenses.
Referrals, Authorizations & Precertifications
Some plans require you to obtain a referral from your child’s primary care physician (PCP), something that should be easy to obtain. For other plans, you may need to get precertification or authorization prior to your child’s first session. We can help you with this step by submitting the proper documentation, but it will still be up to you to make scheduling adjustments if approval takes longer than expected.
Special Notes for Medicaid Families
If your family is on Medicaid, it’s important to keep all of your authorizations and eligibility active. If a visit occurs outside the authorized time period, the cost will likely become your responsibility. We do our best to keep an eye on authorization timelines when scheduling appointments, but it’s ultimately up to you to ensure visits fall within your approved periods.
Understanding Visit Limits for Habilitative Therapy
Insurance plans often place certain limits on therapy visits. These can be per specialty, combined across services, or even shared across several providers/facilities. That’s why it becomes so crucial to keep track of your visits throughout the year. To avoid service interruptions, we’ll notify you when claims are denied due to a maximum being reached. However, it is your responsibility to track your visits.
Regarding these limits, there are a few questions you can ask your insurance provider:
- Are visit limits combined or per specialty?
- Can benefit extensions be requested once I run out of visits?
- Has my child already used any visits under this benefit?
- Are services only covered for injury, neurological, or congenital diagnoses?
How Basal Therapies Supports Families With Insurance
Despite offering plenty of insurance tips, the field is vast and full of hurdles. As providers of speech, occupational, and behavioral health therapy for children, Basal Therapies is quite familiar with insurance navigation. Many families (maybe you included) are likely not. That’s okay! The good news is that you don’t have to navigate it alone. We’re always available to:
- Answer your insurance-related questions
- Help clearly explain your benefits
- Provide assistance with claim denials
We aim to reduce your stress throughout this process as much as possible so you can get to what’s important: your child’s therapy.
You’re Not Alone in the Insurance Process
We know insurance can be overwhelming, especially when you just want your child to start receiving the care they need in order to thrive. The good news? Understanding your benefits and taking advantage of some of the insurance tips we’ve shared here can go a long way towards a smoother process.
Keep an open line of communication with your insurance company and Basal Therapies and you can prevent surprises on the road to therapy. Should you ever have any questions, we’re happy to provide answers. Let’s start a conversation in the interest of your child’s future!
Get in touch!
If you think your child could benefit from our support and services, send us a message!
