The Ugly Side of Therapy...Insurance

Pediatric therapy is a specialized service that has astronomical benefits for children to assist them not only in achieving their highest level of independence at their current age, but also prepares them for their future. There are many numerous positive things we can discuss regarding therapy. However, I would like to discuss the only ugly side today. And that is dealing with insurance. Here is the first reality: Insurance is a necessary evil for most people to be able to afford therapy. With this reality, it means no matter how frustrating it is for the parent or the provider, it is not going away. We must all learn the best ways in which to navigate the insurance system and what roles we each play with the child's best interest at heart. Here is the second truth: Insurance never guarantees payment. Yep, you hear that right. We can verify your insurance and be told you have coverage, however, they always add the disclaimer that "this information is not a guarantee of payment." Great. So what does that mean? It means that each and every policy has different coverage terms. There may be some exclusions on policies for services that are developmentally related (which is ironic when you think about the services we are providing for DEVELOPING children). Some policies may require a pre-authorization by their team, which may or may not be disclosed to your provider when they verify your insurance (again, remember their tag line "this information is not a guarantee of payment"). Third truth: Any phone call to insurance is not going to be short. That goes for all of us; providers and parents. We get your frustration. Our minimum wait time is 45 minutes per phone call. And that is to deal with one child's claims. Now look at the fact that we have over 200 active clients. You can imagine the amount of time we spend on the phone with insurance! So, get comfy and grab a snack to settle in when making your call. Next truth: We are all the child's advocate. As a parent you may have to spend time (sometimes lots of time!) on the phone with your insurance company. The reality is is that you are the policy holder and the relationship regarding your plan is between you and your insurance carrier. As a provider we have very little ability to have them make exceptions or changes to your policy. This is where you will be your child's advocate and spend the time with your provider. We understand that this can be very frustrating, however, this is the role you will play with your insurance provider. Final truth: We are not the bad guys, we are on the same side. As providers we often become the "bad guy" in an insurance situation. If insurance denies your child's claims we will contact your insurance provider to try to understand why and make any corrections or adjustment that we can to get your claim paid. Trust us, we would much rather collect the money from the insurance company than you. However, there may come a point that we cannot fight the claim anymore. At that point, we will need to collect payment for the services we have already provided to your child. This is that financial responsibility part we have in our paperwork. We understand that this is frustrating, but we as a company still need to be paid. Think of it like this, would you eat at a restaurant and then refuse to pay the bill at the end after you have already eaten your food? Most likely not. We are a business in the same way and have already paid that therapist that delivered an amazing service to your child. We understand navigating the waters of insurance can be as varying as the sea; calm on some days and worked up into a frenzy on others. The best part is that we are all on this journey together to provide the best care and opportunities to children.

The Importance of Therapy in the Summer

As we approach the end of another school year, we are closer to the Summer time. Right around this time every year I am asked the same question: "Can we take a break from therapy for the Summer?". The answer is always a resounding "NO!". And why you may ask? Let me share with you the reasons that stopping therapy for the Summer should never be an option. 1. Regression: Regression is the loss of skills that one has already learned or mastered. When a child that has not met and consistently demonstrated the mastery of their goals, they are showing that there are still performance areas that are not up the the developmental age level as expected. Without the consistency and frequency of therapy, their skills that are not mastered will begin to regress. Once therapy is resumed the therapist will need to go back to working on skills that they had already started to make improvements on. This most always ends in frustration for the kiddo. 2. Inconsistency of Schedules: Many children thrive on consistency and predictability. When the Summer arrives they are already lacking a major portion of their routine. Taking therapy out of the picture as well will result in increased frustration and dysregulation. Children can have decreased ability to handle disappointment, have increased outbursts, and a harder time calming down once upset. Routines are very important. Therapy is part of their routine. That shouldn't change. 3. Therapy is not school: Therapy plan of cares are designed with the frequency and duration that the medical professional has deemed are required for your child to meet their goals. Consistency is key to this. It must happen weekly and at the correct frequency. Each child will progress at different rates towards their goals, which is why we have individualized treatment plans. On the flip side, each grade for school has a specific cirriculum for each grade that is set to be completed in 10 months. When the school year is over, the idea is that the goals that were set in the cirriculum have been achieved. They give them a break between the grades as their is a definitive break between goals. Therapy goals are developmentally driven and do not have an end until your child reaches their highest level of independence. 4. Resuming will be HARD: Because children thrive on routines, getting back into the routine of therapy and school come the start of a new school year will be HARD!! For all of you. Therapy is not something that you want to have your child resist coming to because there is so much change happening all at the same time. Hopefully this was helpful information! Work with your therapy provider to help work around vacations and camps so your child can benefit from all the things! Happy almost Summer and cheers to a fun summer of therapy!