Parenting is an amazing experience. Every parent wants their child to thrive. It is an extremely rewarding and challenging job at the same time. Sometimes things come up that cause parents to be concerned with their child’s development. I remember taking my oldest son home the first night after he spent 3 days in NICU and calling the pediatrician because he was breathing fast. I did not have any experience with babies. She assured me that babies breathe faster than adults and made me feel better. Through the years, having 3 boys with autism, I have had tons of concerns. Your child’s pediatrician is always the place to start when you have concerns.
In this blog post, we wanted to give you an idea of how the process of starting speech, occupational, physical, and behavior therapy through insurance works.
Where to Start
The first place to start is with your child’s pediatrician. At a “well visit” you can discuss with your child’s pediatrician the concerns you have, and they will be able to suggest what type of therapies would be helpful to your child, if they believe it is necessary. The pediatrician’s office will be able to give you a list of therapy providers that work with your insurance and initiate a referral to the provider of your choice. Some insurances have case managers. For instance, I have a CMS case manager who gives me a list of providers who have openings and accept our insurance. They usually also have feedback from other parents.
Evaluation
Once your child has a referral for therapy, the parent will need to call the therapy provider that they choose to set up an evaluation. In our next blog post, we will talk about what to expect at the evaluation for each type of therapy. Your therapy provider will complete the evaluation and collect all necessary information and paperwork from you to submit a request to insurance. Evaluation will determine the number of hours/sessions of therapy your child needs.
Insurance Approval
The insurance will review all the submitted paperwork and make the decision to approve or deny the therapy request based on medical necessity. Once insurance approves the request, the therapist can start making therapy appointments. Sometimes a request is denied. If this happens, sometimes the provider can submit extra documentation to support the request. If the insurance denies the therapy request, you do have a right to appeal.
You are on the right path.
Yes, the idea of your child needing services like speech, occupational, physical, and behavior therapy can be overwhelming. Trust me, I know. I have 3 boys with autism. Try and remember to not let it consume you. Getting your child the services they need is putting them on the right path to success. If you suspect your child may be struggling with things like fine motor skills, gross motors skills, speech, and language, etc., your pediatrician can help find a therapist that will identify strategies that will work best for your child and break it down into manageable steps, so it won’t be overwhelming for your or your child. The therapist will help you and guide you every step of the way.
*This is the typical procedure through a Florida Medicaid Provider, given to us by Children Medical Services, Sunshine Health. Other insurances may vary, but this information is to provide a general idea of how the process of starting therapy works to help our families.
Love & Co. Therapeutic Interventions
referrals@loveandcompanytherapies.com
☎ 1 (941) 557-3881
☎ 1 (941) 264-8641
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