Insurance coverage

[Porridge]

Pardon me if this is a naive question. Are there ways to get insurance to cover therapies for things like ADHD / dysgraphia? I don’t mean meds, I mean things like OT or counseling (for anxiety or other related affective disorders). 

[Lecka]

It will depend on your insurance and they are different from each other.

It can also depend on what different offices (OT, etc) accept.

You may or may not need a referral.  You may or may not need a diagnosis.

Insurance might keep a list of providers who accept them.

Sometimes a provider might take your insurance if you ask them about it.  They might choose to do the paperwork for your insurance.  Sometimes this is more of a hassle for a person who is not part of an agency or a small agency and they don’t bother if they don’t know that they would get a client, because they have to fill out paperwork.  Places that are large enough to have a receptionist are often also big enough to take more insurances.  Sometimes the receptionist is also doing insurance billing.  

I think this all varies by location.  This is what my experience has been.

Ime I have had a mix of getting referrals from primary care and calling places and asking if they take the insurance plan.  

 

[Lecka]

My impression is it’s common to either have a co-pay for appointments, or a cap on how many appointments there can be.  Sometimes there is approval for x number of appointments and then they have to submit paperwork to be approved for the next block of x appointments. 

Once you are in somewhere — ime they are the ones submitting insurance paperwork.  

[Storygirl]

Yes, it depends upon your insurance. Ours will cover a certain number of occupational therapy sessions, for example. Before this year, our plan only covered counseling sessions once we had met our deductible (large deductible, so we rarely met it until close to the end of the year). But we have a new plan this year, and it covers mental health 100%.

If you know where you would like to go for therapy sessions, you can call that place, and they should be able to tell you how the billing works for your insurance. Or you can call your insurance phone number (there is a patient info phone number on our insurance card) and ask them about the general policy.

[City Mouse]

Mental health services are usually covered. My DS got some PT (no OT within reasonable driving distance) for “hand pain” that was covered by insurance. Before getting medical PT, My DS had a full evaluation done through his public school but did not qualify for an IEP. Although writing was identified as a weakness, his scores were not low enough to qualify. Since he did not qualify for SPED his dr could argue with the insurance company that his problem was medical not educational, and his hands really did hurt when writing.