How Insurance Works at Associates in Pediatric Therapy
Let’s be honest: insurance can feel confusing. Between deductibles, copays, coinsurance, and visit limits, it’s a lot to keep track of, especially when your main focus is getting your child the support they need. We get it. That’s why we want to break down how insurance works at Associates in Pediatric Therapy in a way that actually makes sense.
What Insurance Plans Do You Accept?
We accept most commercial insurance plans, Medicaid, and Medicaid waivers. That said, every plan is a little different. Before your child’s first appointment, we recommend calling the
customer service number on the back of your insurance card to confirm that APT is in your network. Our billing team is also happy to help verify your benefits and walk you through what to
expect.
Understanding the Basics
Here are a few key terms you’ll likely come across when reviewing your insurance coverage: Your deductible is the amount you pay out of pocket before your insurance starts covering
services. For example, if your plan has a $2,000 deductible, you’ll pay the full cost of therapy sessions (at your insurance company’s contracted rate) until you’ve reached that $2,000
threshold. After that, your insurance kicks in.
A copay is a flat fee you pay at each visit, like $30 per session. This amount stays the same regardless of what the service costs.
Coinsurance works a little differently. Instead of a flat fee, it’s a percentage of the cost. So if your coinsurance is 20% and your session costs $100, you’d pay $20 and your insurance would
cover the remaining $80. Keep in mind that coinsurance typically applies after you’ve met your deductible.
Your out-of-pocket maximum is the most you’ll pay in a plan year. Once you hit that number, your insurance covers 100% of covered services for the rest of the year. Some plans include
your deductible in this total, and some don’t, so it’s worth double checking your specific policy.
Visit Limits and Plan Years
Many insurance plans cap the number of therapy visits covered each year. These are sometimes called “max visits.” Once you’ve used them, you’re responsible for the full cost of
additional sessions. It’s also helpful to know whether your plan runs on a calendar year (January through December) or a fiscal year (which could be any 12-month period, like June to May). This affects when your benefits reset. Some plans also have combined visits, meaning all therapy types (occupational therapy, physical therapy, and speech therapy) share one pool of visits. Others separate them by discipline, giving you a set number for each. Our team can help you understand what your specific plan allows.
What If Something Isn’t Covered?
Insurance plans sometimes exclude certain services or conditions. This is called a benefit exclusion. If you’re unsure whether your child’s therapy will be covered, we’re happy to help
you find out before you start. We also work with families who have self-funded plans, which are employer-sponsored plans where the employer pays claims directly rather than through an insurance company. These plans can have different rules, so it’s especially important to verify your benefits ahead of time.
We’re Here to Help
Navigating insurance doesn’t have to be stressful. Our billing team is just a phone call away at 502-633-1007 (option 4). Whether you need help verifying your benefits, understanding your
out-of-pocket costs, or figuring out what’s covered, we’re happy to guide you through it. At Associates in Pediatric Therapy, we believe the billing process should be as simple as
possible so you can focus on what really matters: your child’s progress.