Tips for Dealing with Insurance Companies

 Navigating Insurance for Your Child's Therapy

As parents, we want the best for our children, especially when it comes to their health and well-being. If you’re considering speech or occupational therapy for your child, it's important to understand that insurance coverage can be complex and uncertain.

Steps to Take When Contacting Your Insurance Company

When you call your insurance provider to determine if therapy is covered, be prepared to provide detailed information:

• Your name, contract number, and other identifiers
• Possible procedure codes (CPT) for evaluations and therapies
• Potential diagnostic codes (if applicable after evaluation)

Always take detailed notes during your conversations, including the full names of representatives, dates, and extensions for future reference. This will help you keep track of who you spoke to and what was discussed.

Common Questions to Ask Your Insurance Company

• Under what circumstances is speech or occupational therapy covered?
• Are there any age restrictions, visit limits, or percentage covered?
• Are developmental issues in children covered, or is therapy only covered in case of an injury?

If coverage is confirmed, request written approval or specific reasons for rejection. Keep this documentation safe.

Handling Denied Claims

If your claim is denied, don't lose hope. Here are some tips:

• Always appeal the decision, even if it takes multiple attempts.
• Keep all correspondence and documentation organized in one file.
• Document all phone calls, noting names, dates, and discussion points.
• Keep copies of everything you send to the insurance company, as information can get misplaced.

If initially denied, ask for the denial reason in writing and address these issues in your resubmission. Enlist the help of your child’s pediatrician or neurologist; a prescription stating the therapy is "medically necessary" can be beneficial.

Additional Tips

• Insurance policies often favor coverage when interpreted ambiguously. Courts typically rule in favor of coverage.
• If all appeals fail, you can file a grievance with your state’s insurance overseer.
• Share any tips or experiences with us so we can support other families navigating similar challenges.

We hope these guidelines help you advocate effectively for your child’s needs. If you have any questions or need further assistance, please don't hesitate to reach out.