Q: What is Speech Therapy?
A: Speech Therapy, also known as Speech Language Pathology, is the study, diagnosis, and treatment of voice, articulation, communication, and written language disorders. The evaluation and treatment of neurological/physical disorders caused by trauma or illness are also addressed. Examples of such disorders may include difficulty swallowing, motor speech disorders, and cognitive disorders.
Q: What is Occupational Therapy?
A: Occupational therapy facilitates fine motor skills, gross motor skills, self-care, and sensory integration skills to help achieve independent functioning in everyday life. Working with fine motor skills, for example the small muscles in the hand, will build strength to help a child write or use scissors to cut.
Q: What is Physical Therapy?
A: Physical therapists are dedicated to improving and restoring physical skills, by strengthening those areas to increase mobility, balance and flexibility. They work with difficulties involving gross motor function in the major muscle groups. Physical Therapy goals often include help with developmental milestones such as sitting, standing, crawling and walking.
Q: Will my insurance cover an evaluation and/or therapy?
A: Most often, insurance will cover at least a portion, if not all of an evaluation. Coverage for therapy services will depend on the individual insurance plan, and it is often determined by medical necessity. It is each family's responsibility to verify insurance benefits prior to receiving services. We will take a copy of your insurance card to verify your benefits; however, it is ultimately the family's responsibility to research as well.
Q: What insurance plans do you currently accept?
A: We are currently in-network for BCBS, UHC, Aetna, Humana, Straight Medicaid, CMS, Medicare HMO's (Amerigroup, Staywell, Sunshine), MediPass, Cigna and TriCare Military Insurance. Although we are out of network with some insurance companies at this time, you may still be eligible for coverage depending on your plan. In addition, being in-network does not always guarantee coverage for disorders that are developmental in nature. Please call the office to discuss your options.
Q: Do I need a script from the doctor to begin?
A: Yes. A prescription from your doctor or your child's pediatrician/specialist is a necessary part of beginning evaluation/therapy services. It keeps all of us on the same page to provide the best plan for assessment and intervention. The script should read: Speech Therapy Eval and Treat, Occupational Therapy Eval and Treat, or Physical Therapy Eval and Treat. In addition, the diagnosis code number should be listed on the script (i.e., developmental disorder, articulation disorder, auditory processing, sensory processing, torticollis, expressive language delay, etc).
Q: What is a GAP exception?
A: Sometimes, your insurance company WILL allow you to go out of network for services, and still receive in-network coverage. This is called a Gap Exception ("in for out"). This type of exception is related to distance - can you find another provider under your insurance plan that is within a 30 mile radius of your home? If not, we may be able to get you qualified for a Gap Exception.
You can also get a Clinical Gap Exception through your insurance if you are pursuing our clinic for a specialized intervention plan that cannot be found at another area clinic (i.e., Interactive Metronome, Feeding/Swallowing Therapy, Myofunctional Therapy).
Q: What happens during our first visit?
A: Please plan to arrive 10 minutes early for your first appointment. You may download forms on-line, under "Resources" on the homepage of this website or by clicking here. These forms are password protected, so you will need to contact the office to obtain access. Your therapist will come out to greet you in the waiting room. Your child will be asked to remove his/her shoes, and he/she may choose a pair of socks to wear throughout their visit. This is to keep a healthy, clean environment for everyone and for the safety of the mats in the gym (yes, even the parents please!). Your therapist will then ask background questions and establish rapport in a playful manner. Your child will be put at ease immediately--this is a comfortable, fun, and playful place to be!
Q: How long will my child need therapy?
A: Typically, a treatment plan is established over 6-month increments. Your child will have his/her initial evaluation completed with treatment goals established to be achieved within a 6-month period. Sometimes therapy can extend for longer periods of time depending on progress, diagnosis, and severity of the disorder. Individual treatment plans are established, and parents play an integral role in treatment planning. You can expect that your child will participate in a re-evaluation every 6-9 months to determine if therapy goals need to be revised and to monitor progress. Your insurance may require more frequent documentation, in which case, it is your responsibility to notify your therapist what is required.
Q: Do I need to verify my benefits with my insurance?
A: Absolutely, you should always know your insurance benefits. When we call your insurance to obtain your benefits, we given a quote. This means, there is no guarantee of payment until the claim is received. Sometimes, insurance will only pay for medical necessity diagnoses, so it is required that you understand and call to check on your benefits as well.
***If you have Aetna, UHC, BCBS or Humana, the SPEECH THERAPY billing is done through Florida Pediatric Associates, LLC (FPA). There are different rates for denials when using these insurances vs. going directly through CCAM as a private pay customer. Please inquire with the office regarding your insurance questions. You may need to obtain a referral that contains a medical necessity from your child's pediatrician to aid in coverage for services. Please call the office to inquire about your specific questions. It is best to be informed before a service is rendered!