When thinking about an insurance plan for your child’s therapy…

~Tips to choose the right insurance for you and your family~

It is that time of year again! Open enrollment is a crucial time to consider visit limits and financial restrictions and how they align with your family’s needs. I have compiled a comprehensive list of important considerations when reviewing an insurance plan for physical therapy needs. This is a thorough approach to ensure that you are well-informed about the coverage and can plan accordingly.

Network consideration-

• Check if the physical therapy provider or clinic is in-network or out of network.
  • While we are contracted with most insurance there are some we are out of network with.
• Understand the implications of in-network versus out-of-network coverage.
  • If we are out of network with your plan, contact our billing specialist first to see if there are alternatives available based on your plan.

Visit Limitations-

• Examine how many physical therapies visits your child utilized in the previous year.
  • This serves as a baseline for estimating future needs.
• Assess if there’s flexibility in the plans, such as the option to request additional visits beyond the specified limit and understand the process for doing so.
• Determine the number of visits allowed in a calendar or plan year.

Authorization Process-

• Check if prior authorization is required.
  • An Authorization typically determines a set number of visits for a specific time frame. This is true for companies such as Evicore or Optum.

Financial Considerations-

• Review deductibles and out-of-pocket maximums.
  • If there is a deductible, is it combined or separate?
• Understand if there’s a set copay or if costs are covered differently.
  • Anticipate any changes in your child’s health condition that may affect the frequency of physical therapy visits in the upcoming year.

Exclusions-

• Check for any exclusions related to specific diagnosis codes.
  • While IPT performs courtesy benefit checks (typically online), Insurance companies that do have specific exclusions do not typically disclose this except in the fine print or when directly asked.
• Understand conditions under which coverage may be denied.

Note-Taking and Documentation-

• Take detailed notes during calls with insurance providers.
• Ask for a reference number, the representative’s name, and note the date and time of the call.
• Store this information for future reference.

Alerting Changes to ALL Service Providers-

• Notify the physical therapy provider of any changes in your insurance plan promptly.
• Ensure that the provider has up-to-date information for authorization and billing purposes.
  • This proactive communication assists in managing to avoid retroactive requests or denials.

By systematically considering these factors, you can select an insurance plan that aligns with your family’s budget and adequately covers your child’s physical therapy needs. Please also feel free to email or call me at 971-405-0454 with any questions. Allie Matthews~