INSURANCE GUIDE FOR FAMILIES
General Information
Many health insurance plans offer partial coverage for pediatric occupational therapy services. Coverage may include limitations such as deductibles, visit caps, diagnosis requirements, or network restrictions.
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Every insurance plan is different—even plans from the same insurance company can vary significantly. Because of this, it’s important to verify your specific benefits directly with your insurance provider.
Using Insurance at ChildSync
ChildSync is considered an out-of-network provider for most insurance plans, though we do maintain limited relationships with select insurance companies. Because coverage varies by plan, reimbursement for services is not guaranteed.
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Before services begin, we ensure families clearly understand:
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The cost of services
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Potential insurance reimbursement scenarios
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Their financial responsibility
Superbill Provision
ChildSync does not submit insurance claims on behalf of families. Instead, we provide superbills for occupational therapy services.
A superbill is a detailed receipt that includes the information insurance companies typically require for out-of-network reimbursement, such as:
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Provider and practice information
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Diagnosis codes (ICD-10)
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Treatment and evaluation codes (CPT)
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Dates of service and fees paid
Families are responsible for submitting superbills directly to their insurance company and following up on reimbursement.
Insurance Decisions and Reimbursement
If you plan to seek insurance reimbursement, we strongly recommend contacting your insurance company before services begin . This helps you understand your benefits and avoid unexpected expenses.
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Questions to Ask Your Insurance Company
We recommend asking your insurance provider the following:
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Are there in-network pediatric occupational therapy providers in my area?
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Does my plan cover out-of-network pediatric occupational therapy services?
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Are there specific diagnoses (ICD-10 codes) that are covered or excluded?
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Which treatment codes (CPT codes) are covered?
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Evaluations: 97165–97167
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Treatment sessions: 97110, 97530, 97112, 97535
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Do I need a prescription or referral from my child’s pediatrician?
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Is prior authorization or precertification required?
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How many sessions are covered, and within what time frame?
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Do I have a deductible, copay, or coinsurance, and what are the amounts?
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What documentation is required when submitting a superbill?