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January 8, 2020

Navigating Insurance and Pediatric Therapy Services

A primer on paying for therapy for your child

When your child has a physical or developmental condition that keeps him or her from doing the same things as other kids the same age, you want answers and access to therapy that will help. Of course, there is also the question of how you will pay for physical, occupational, speech, or ABA therapy services.

In this blog, we’ll look at insurance considerations for pediatric therapy and the support available to help cover treatments your child may need.

Who we are

Lumiere Children’s Therapy is here to provide treatment and support for children in need, education for their families, and to give hope that your child can improve and achieve traditional milestones. We strive to create experiences that help forge connections between parents and children, while also revealing the potential in each child, regardless of their skills.

Our services include:

  • Speech therapy
  • Occupational therapy
  • Developmental therapy
  • Physical therapy
  • ABA therapy – Applied Behavior Analysis for Autism Spectrum Disorder (ASD)
  • Social work
  • Augmentative alternative communication
  • Early intervention
  • Teletherapy

If your child is struggling with speech, physical impairments or developmental delays, we can help. And we will do our best to work with your insurance and other sources of funding to provide the services your child needs.

Does your insurance cover therapy for children?

Most private and public health insurance plans do cover therapy for your children. These services can include physical, occupational, speech, and ABA services along with other types of services, reimbursement, and limitations that vary according to plan.

The Affordable Care Act (ACA) added new requirements for insurance companies to help families pay for children’s therapy services. The Act prevents insurers from denying coverage due to pre-existing conditions and eliminates coverage caps. It also requires that plans cover physical, occupation, and speech therapy for children. This applies to plans that are non-self-funded. Self-funded plans will often have specific guidelines and requirements that are written for that plan. It is always important to call your insurance company and have verification of benefits. Lumiere makes this part of its new client onboarding process to minimize confusion with accessing services.

The Individuals with Disabilities Education Act (IDEA) stipulates that insurance plans must include provisions for pediatric therapy for children from birth through age 21 if they are eligible for early intervention (Part C) or special education services (Part B).

Understand what your insurance covers

Every insurance plan is different. There are different levels of coverage that relate to co-pays, deductibles, and limitations in terms of reimbursements and the number of visits allowed. In addition, some therapies may be covered while others are not.

If you are unsure what is covered, call your insurance company before your child begins therapy. Also, check for coverage that may be included in any secondary health insurance plans in your household.

Be sure you can answer these questions about your child’s insurance coverage:

  • Does your plan include coverage for the type of therapy you are interested in?
  • How many visits are included in your plan for the specific services you need?
  • If your child needs different kinds of therapy (physical, occupational, speech, developmental, etc.) are they each allowed the same number of visits?
  • What are the exclusions or limitations?
  • Does your insurance cover therapy relate to developmental delays?
  • Do you need a referral from your child’s primary pediatrician or other specialists?
  • Does your insurance require a new referral every 12 months?
  • Does your insurance need to review your child’s plan of care and authorize the required number of visits?
  • How much are you required to pay out of pocket? (Including co-pays, co-insurance, deductibles, etc.)

Lumiere accepts all forms of a major insurance and is in-network with Blue Cross Blue Shield PPO’s, Meridian (MCO), and works with the Early Intervention Program. We will verify the benefits of all types of insurance.

Resources to help pay for therapy

Even with insurance, many families struggle to pay for pediatric therapy. It can be expensive, but there are resources to help ease the burden. You may qualify for subsidies, grants, and in some cases, Medicaid.

Many organizations also offer special needs grants that can help pay for treatment. Here are some resources to investigate.

Lumiere does offer membership plans at a discounted rate for sessions purchased.

Lumiere: lighting the future for all children

We all have strengths and weaknesses. We believe that therapy, family education, and trust can help children thrive, despite any obstacles they face. With Lumiere, you get access to a team of specialists who will create a personalized plan to help your child reach every milestone and be more independent.

If you need information about how we work with your insurance coverage or other ways to pay for therapy, give us a call to discuss your options.

Lumiere Children’s Therapy is a full-service, multidisciplinary pediatric therapy practice located in Chicago that serves the developmental needs of children from birth to 18 years of age. Learn more about how our team of clinicians works to improve the lives of children and their families.

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