by Erika Goyer, Hand to Hold Parent Support Navigator and Kimberley Johnson, mom to Blake who spent 14 months in the NICU & PICU
In other articles we’ve talked about importance of seeing a pediatrician for periodic developmental screenings. But what do you do if you and your doctor have a concern? You get your child’s doctor to write them a prescription for therapy.
Most health insurance plans, including Medicaid, provide benefits for occupational, physical and speech therapies – although they may only cover a limited number of visits each year. The number of visits your child is approved for will depend on your child’s age, diagnosis and treatment plan. Talk to your doctor about supplying a letter of medical necessity to your insurance provider. Whether or not the services are approved often depends on how you ask. You may find it useful to have your pediatrician and therapist talk directly to one another as they design your child’s program. Open communication and collaboration can result in more services and therapy visits for your child!
Once you have a prescription you will want to choose a provider. Ask your pediatrician, friends, and other therapists for suggestions. You can also visit Hand to Hold’s searchable, Online Resource Directory. Then be sure to call your insurance company and get a list of preferred providers. But here’s something to remember: You are not necessarily limited to that list. If your insurance provider does not have therapists who specialize in pediatric therapy (and that is what your prescription is for) you may be able to get in-network reimbursement for out-of-network therapists. See this website for more insurance tips.
Therapy is an investment and it is okay to consider the costs. Don’t be afraid to talk to any therapy practice you are considering about your concerns. You’re entering a long-term relationship with them and it is better to know that you have someone who understands your family’s financial situation and can work with you than to be surprised by bills you struggle to pay. Besides, most practices have years of experience working with insurance companies! Let them help. Read “Navigating Claims, EOBs and Insurance Companies” by mom, Kathryn Whitaker.
Your child’s first therapy appointment will be longer than most. You will discuss your child’s developmental history, so be sure to bring notes with you about developmental milestones and when your child reached them. You will also talk about your concerns. Then the therapist will take some time to evaluate and assess your child. The therapist will observe your child doing different activities such as playing with toys, standing, sitting, moving and making transitions between activities. This is your chance to see how the therapy team relates to your child. Are they engaging? Is your child comfortable with them? Remember: Not every therapist will be a good fit for your child. So take this opportunity to “audition” the staff. For example, Kim’s son Blake has to have a real connection with his therapist to be successful. She says that when his therapists are playful and stay excited he has so much fun that he forgets how hard he’s working.
After you review and discuss these assessments with the therapist, you all will come up with a treatment program. You should expect to stay with your child for the entire appointment for this first assessment, although at future appointments you may discover that your child works differently – or even harder – if you are not in the room. This of course depends on your child’s temperament and the rapport they develop with their therapists.
Whatever the case, it’s important that you continue to communicate openly with the therapists. It’s typical to review your child’s progress and do a reassessment every six months. But the most important thing is that you agree on the goals of your child’s therapy and how you’re going to achieve them. Because therapy isn’t just the time you spend in appointments. It’s all the little things you do every day to support your child’s development!
Erika Goyer is the mother of three boys and a family support navigator with Hand to Hold. Her oldest son Carrick Michael was born at 27 weeks gestation and weighed 1 pound, 14 ounces. Carrick died soon after his birth due to complications of prematurity. Erika went on to have two more high-risk pregnancies and two healthy sons, one of whom has developmental delays.
Kimberley Johnson is the mother of Blake (pictured above) who spent 14 months in the NICU and PICU.