What Choices Does Your Insurance Offer

Researching your options and asking questions of your health insurance company can help you make an informed decision when choosing a provider of healthcare services. Each insurance company has a Member Services department you can and should contact before starting treatment with a provider so you know what your responsibilities are and what to expect. Below are some suggestions of questions, and you will most likely have more of your own.

Questions to Ask Your Health Insurance Company

Coverage
  • If I have yearly limits, when does my year start and end?
  • Are there any types of services provided by a physical therapist, occupational therapist or speech-language therapist that are not covered regardless of medical necessity?
  • What is the coverage amount per therapy session?
  • What amount would I need to pay for each session?
  • How many sessions per year does my health insurance cover?
  • What is the process to have genetic testing covered?
More on Coverage
  • Do you cover intensive therapy (two plus hours daily for one or more weeks)?
  • Do you cover the cost of the equipment needed to carry out the therapy (i.e., braces, splints, etc.)?
  • What specialty therapies are covered (i.e., aquatic therapy, hypnotherapy)?
  • Does insurance reimburse for gas mileage for long-distance trips to see specialists?
  • Do you cover out-of-state providers?
  • For special needs children, what other types of items (such as diapers) will insurance pay for?
Requirements
  • Are there diagnoses that would prevent covering these therapies?
  • Is a referral from my doctor needed?
  • What documentation does my provider need to submit to demonstrate medical necessity for the services?
  • Is insurance pre-authorization or pre-certification needed?
  • How long does it take to get pre-authorization once submitted?
  • Do I have to use certain providers?
  • If so, where can I find the list of approved providers?
Policy
  • What is my deductible amount and has it been met?
  • Where can I find a copy of my policy that defines my child’s benefits for this type of therapy?
Appeals
  • What is the appeal process?

Resources

Services for Patients & Families in Montana (MT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Last update/revision: August 2019
Current Authors and Reviewers:
Reviewer: Mindy Tueller, MS
Funding: Thanks to the 2013-14 Portal Utah Regional Leadership Education in Neurodevelopmental and related Disabilities (URLEND) Trainee group for their effort on this project.