What Choices Does Your Insurance Offer

Researching your options and asking questions of your health insurance company can help you make an informed decision when choosing a provider. Each insurance company has a Member Services department you can and should contact before starting treatment with a provider so you know what your responsibilities are and what to expect. Below are some suggestions of questions, and you will most likely have more of your own.

Questions to Ask Your Health Insurance Company

  • 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?
More on Coverage
  • 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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Authors & Reviewers

Initial Publication: August 2014;
Current Authors and Reviewers (click on name for bio):
Funding: Thanks to the 2013-14 Portal Utah Regional Leadership Education in Neurodevelopmental and related Disabilities (URLEND) Trainee group for their effort on this project.