- Are there any types of services provided by a physical therapist, occupational therapist or speech-language therapist that are not covered regardless of medical necessity?
- What is the coverage amount per therapy session?
- What amount would I need to pay for each session?
- How many sessions per year does my health insurance cover?
- If I have yearly limits, when does my year start and end?
- What is the process to have genetic testing covered?
- Do you cover intensive therapy (two plus hours daily for one or more weeks)?
- Do you cover the cost of the equipment needed to carry out the therapy (i.e., braces, splints, etc.)?
- What specialty therapies are covered (i.e., aquatic therapy, hypnotherapy)?
- Does insurance reimburse for gas mileage for long-distance trips to see specialists?
- Do you cover out-of-state providers?
- For special needs children, what other types of items (such as diapers) will insurance pay for?
- Are there diagnoses that would prevent covering these therapies?
- Is a referral from my physician required?
- What documentation does my provider need to submit to demonstrate medical necessity for the services?
- Is insurance pre-authorization or pre-certification required?
- How long does it take to receive pre-authorization once submitted?
- Do I have to use certain providers?
- If so, where can I locate the list of approved providers?
- What is my deductible amount and has it been met?
- Where can I find a copy of my policy that defines my child’s benefits for this type of therapy?
- What is the appeal process?
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|Compiled and edited by:||Mindy Tueller, MS - 8/2014|