It’s the end of the year and we are in the middle of the holidays, which can be very fun and exciting!  BUT it’s also the time of year when employers will review insurance plans and benefit levels for their company as well as their employees!  This can be confusing and frustrating as we try to sort out what benefits are covered as well as which services are limited or excluded.

I would love to try to help families understand their health insurance when it comes to the services that Kid Talk provides to your children.  When you are given the option between different insurance companies and different plans, here are some questions that may be helpful to ask before committing to a plan:

1: Is speech and/or occupational therapy a covered service?  If yes, are there any diagnosis code exclusions?

When your primary care physician refers your child for therapy, s/he will generally give a diagnosis code that indicates why the child would benefit from therapy.  When our therapist(s) perform(s) an evaluation, they may determine additional diagnosis codes that indicate “why” that child would be receiving services (for example: Expressive Language Disorder or Sensory Processing Disorder).  Some insurance companies when asked will indicate that “yes” speech and/or occupational therapy is a covered service, but the plan may have diagnosis code exclusions, which they may not specify.  When this happens, we won’t know that a service is/isn’t covered until we submit the first claims for payment.  It is extremely helpful to call your insurance company once the evaluation is completed and ask if speech and /or occupational therapy is a covered service as well as any diagnosis code exclusions!  Knowledge is powerful in these situations and can better help you and your family plan financially for therapy.

2) Is there a visit limit for therapy?

Some plans may have a hard visit limit for therapy (i.e. 50 visits per calendar year) and no additional visits will be covered.  Other insurance plans may have a soft limit in which they will allow for X number of visits and then any beyond that number will require authorization paperwork to be submitted in order to request additional visits.  And some insurance plans may allow for unlimited visits as long as the service is viewed as medically necessary.

3) Do I need a prior authorization in place?

Some companies, such as Health Partners, require that we submit the initial assessment as well as a request for the number of visits indicated for that child.  They then will either authorize or deny coverage for speech and/or occupational therapy.

These are just a few of the considerations that we face regarding benefits and coverage of skilled services!

Here are some final reminders as we transition into 2017:

  1. Whenever you receive any communication from your employer or insurance company that you feel could involve speech and/or occupational therapy coverage, it is always best to be proactive with calling and asking questions related to the changes.
  2. Whenever you get a new insurance card, please remember to bring it in to Kid Talk to make sure we have the most up to date information in our system to submit claims for your child.
  3. With the new year upon us, please remember to share any insurance changes with Kid Talk so that we can make sure to be as on top of any changes with your coverage as we can be!
  4. And most importantly, please remember that if you have any questions that I can help with, give me a call at (952) 443 – 9888!

Happy New Year!