Paying For Therapy

Therapy is often a necessity for children who grow up with disabilities. Participating in physical, speech, and occupational therapy can help children with disabilities to improve and become more  confident. While these therapies are important, and oftentimes crucial, they are undoubtedly expensive, and typically have  only have a limited number of sessions covered by insurance. Due to this, it is important for families of children with disabilities to consider the options available when it comes to financing therapy over the course of their child’s life.

Therapy Costs and Health Insurance

Some individuals and families have private health insurance plans that may help cover a portion of these expensive therapies. Others enrolled in public health programs like Medicare may also be eligible for financial assistance for therapy costs. In both of these circumstances, there are limitations and qualifications that surround the amount of money an insurance program will extend towards therapy services, and the type of services they will cover. While it is important to know the specifics of your own insurance program, there are general guidelines that most insurance programs follow.

  • Medical Necessity: Most insurance providers, both private and public, will only fund therapy costs when the therapy is considered a medical necessity for the individual. In most scenarios, disability therapy is considered a medical necessity.
  • Therapy Caps: Insurance plans usually have a built-in amount of coverage for therapy. When costs reach this fixed amount, the insurance company will stop paying for therapy. These caps differ depending on the plan. Some plans have separate therapy caps for physical, speech, and occupational therapy. It is important to look into the therapy cap of your insurance contract when financing therapy.
  • Therapy Cap Extensions: In certain circumstances, beneficiaries might be eligible for a therapy cap extension, where the therapy cap amount increases and the insurance company will cover the cost of more therapy. Some children with disabilities are qualified for therapy extensions, since their therapy is considered crucial for development.

When considering therapy for children with disabilities, it may be helpful to look into the details of your insurance plan to assess whether or not certain costs can be covered due to your circumstances.

Handling the Remaining Therapy Costs

If your family does not have insurance, or if therapy costs exceed the therapy cap, there may be several options that may be used to help finance the remaining costs.

  • Financial Assistance Programs: Some hospitals and therapy providers understand the expensive nature of their services and the potential burden this could place on their customers. Because of this, some hospitals and therapy centers offer financial assistance programs for their patients. These programs can be set up in a variety of different ways based on both the patient and the hospital. Financial assistance programs typically take into account the following factors when deciding on a patient’s eligibility for assistance:
    • Patient’s residence – Priority is often given to those that live within the defined “service area” of the hospital or therapy center.
    • Family income – There are often income cutoff criteria that is assessed in the eligibility process.
    • Patient’s assets – Oftentimes these programs extend their support to individuals who do not have insurance or other financial assets that help to pay for therapeutic services.
  • Negotiation: Insurance companies are often charged lower rates for therapeutic services than are individuals who pay out-of-pocket. If you are paying out-of-pocket for your therapy, you may be able to negotiate an agreement with the therapy center that allows you to pay the reduced fee given to insurance providers. This tactic is most effective if you are able to pay for services in cash in full, allowing therapy providers to avoid extra expenditures during billing.
  • Alternative Plans: If you have out-of-pocket therapy costs and are worried about paying them right away, therapy providers can often arrange payment plans. Some ways that therapy providers can help you cut costs are:
    • Flexible scheduling: Therapists may offer to see your child on a less frequent basis, so long as it does not lessen the effect of therapy. This may lower costs.
    • Sliding Fee Scale: Some organizations may work on a sliding scale payment method in which families with lower overall incomes pay less per therapy visit than families with higher incomes. These programs often help families with average to below average annual incomes.
    • Payment Plans: Oftentimes, therapists may allow patients to pay a portion of their fees upon treatment, and add the remainder to a tab that they may pay off over time. These may help families who are going through a difficult financial time, and may come into more stability in the future.

If there are still outstanding therapy costs after insurance coverage, there may still be other resources like special needs trusts and tax benefits that may help to ease your financial situation. Visit our other financial resources to learn more about these options.

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