Insurance Questions

Questions to Ask Your Insurance Company About Occupational Therapy


1.  Does my insurance plan cover Occupational Therapy?

2.  Do I have to get a letter from a licensed medical provider (Physician or Physician’s Assistant) to state this is medically necessary?

3.  Do I need to send the letter from the medical provider before seeing the Occupational Therapy provider OR can it be submitted with the first bill?

4.  Is a diagnostic code required for reimbursement?

5.  What is the reimbursement scale for Occupational Therapy?

6.  What is the deductible on the plan? $__________ (amount)

7.  Is there any deductible left to meet this year?

$__________ (amount)

8.  Is there a limit on the total amount that can be paid out each year? $__________ (amount)

9.  Is an Occupational Therapy Evaluation covered by my insurance? $__________(amount)

10. How many Occupational Therapy sessions will be covered by insurance in total per year? $__________(amount)

11. Does my coverage extend to the services of a non-network provider?

12. What is the maximum covered cost per Occupational Therapy session? $__________(amount)

13. What is the Co-payment per Occupational Therapy session? 


14. Must we be referred for Occupational Therapy by a medical doctor or is an OTR sufficient?

15. If we are already in Occupational Therapy with another provider, what is my remaining coverage for Occupational Therapy this year? $__________(amount)

16. Does my insurance cover the following codes:

  • 299.00 autism
  • 315.4 coordination disorder
  • 728.9 disorder of muscle ligament/muscle hypotonicity
  • 781.3 motor incoordination
  • 781.92 abnormal posture . 

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