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How to get speech therapy and occupational therapy covered when your insurance won’t cover it

Many times when someone calls, the first question they ask is “Do you take our insurance?”, which is sad, because the first question really should be, “What kind of therapy do you provide and are you the best place to help my child?”. Wouldn’t it be wonderful to go to the BEST clinic for your child and see the BEST therapists, and insurance would cover wherever you chose? Here are some tips to help get some, maybe all, fees covered:

What is your copay rate?

I have found that copays are close to and sometimes even higher than my private pay rate. Ask your insurance company before you start looking around what your copays would be so you can compare.

Out of Network Benefits

Some insurance plans cover therapy providers out of network at a different rate. We would provide you a “Superbill” which is an itemized statement for each visit with costs, diagnosis codes, and treatment codes in the format to submit that to your insurance company. You need to call your insurance company to find out if your plan has this option.

Out of Network Exceptions

I am PROMPT certified and currently there is no other provider within a 120 mile radius that has the same certification. I am also LAMP certified with very few providers in the same radius. Because of these specialized certifications, you can call your insurance company and ask for an out of network exception to get therapy covered. We can provide a letter and proof of why your child needs to come to OUR clinic. In addition, many other clinics have long wait lists which is another reason for an exception.

HSA and HRA account

You can use HRA and HSA accounts to cover speech and occupational therapy.

Scholarship and Grants

You can apply for scholarships and grants to pay for therapy. Here are some popular ones:

United Healthcare http://www.sertomacenter.org/united-healthcare-grants-for-k/
The Orange Effect Foundation: http://theorangeeffect.org/grant-application/
Small Steps in Speech http://www.smallstepsinspeech.org
Gardiner Scholarship- https://www.stepupforstudents.org/for-parents/special-needs/how-the-scholarship-works/
Special Kids Therapy- http://www.specialkidstherapy.org

Pick the BEST place for your child to go to therapy. Going somewhere just because they take your insurance, can lead to poor results and a waste of time.

Nicole Yates
About the author

I have been working in the speech-language field since 2007. I received my undergraduate degree from the University of Florida in 2006, and my masters from University of South Florida in 2009. I have worked in the school system, hospital, independent clinic, and home health settings. I decided to leave the hospital to work for myself, because I was frustrated with the amount of children required for me to see daily. Starting my own company has allowed me time to adequately prepare for each of my patients so that I can serve them and their families in the best way possible. Every child is so different, and I can now give them the time they need. I myself was in speech therapy as a child and know what it feels like not to be understood. It is my passion to help every child reach their fullest potential in the area of communication. There is nothing more fulfilling than hearing a child tell their parents they love them for the first time! I would be grateful to be a part of your child’s journey.