What to do next, if you think your child might need occupational therapy?   

Contact us to schedule a FREE consultation.

What happens after the first consultation?

If an occupational therapy evaluation is determined appropriate, the therapist will suggest for you get a referral from your primary care doctor if you want out of network reimbursement. Once you have the referral you can schedule a comprehensive occupational therapy evaluation or a feeding evaluation. If you are not seeking insurance reimbursement, you may schedule your evaluation immediately.

What are the types of Occupational Therapy evaluations are offered and what can I expect?

Steps Ahead OT offers a comprehensive occupational therapy evaluation. If the child has feeding challenges the evaluation will include a feeding portion to the evaluation. Evaluations range from 1.5-2 hours in length. Evaluations typically consist of standardized testing, clinical observations, and parent-report measures. Because all children are different, your evaluating therapist will determine appropriate testing methods based on your child’s needs.  A pediatric occupational therapy evaluation may include assessment of: Gross/sensory motor, fine motor, activities of daily living (ADLs), sensory processing skills, functional vision skills, visual motor/perception skills, play skills, executive functioning skills, feeding/oral motor and primitive reflexes.

Do I receive a report?

You will receive a detailed evaluation report and plan of care via our HIPAA compliant software system (Fusion), within your personal client portal approximately 7-10 days after the assessment. If you have any questions after reviewing the evaluation report, we can set up a complimentary phone consultation with you.

(If your child already has a recent evaluation, a year or less, from another facility, we may be able to use that evaluation to prepare a plan of care and begin treatment.)

When would my child start occupational therapy?

If the evaluating therapist has determined your child would benefit from therapy, you may begin scheduling sessions immediately after the evaluation, while waiting for the full report.

Do you accept insurance?

Steps Ahead OT is currently an out of network provider. You are expected to pay for services when provided.

How do I determine if I have out of network insurance benefits?

Every insurance plan is different, so this is a tricky question to answer. The best thing to do is contact your insurance company, and ask them the following questions:

1) My child will be receiving occupational therapy from an out-of-network provider. Does my plan provide any reimbursement for this? (example: 60% of the eligible charge is reimbursable, 40% is patient responsibility + amount above the eligible charge)
 
 2) Are there any diagnosis/condition limitations that would disqualify my child from receiving benefits, such as no coverage for developmental delays?
  
3) Does my child need prior authorization in order to receive above benefits?
a) If yes, will the evaluation be eligible for reimbursement or do I have to receive the prior authorization before I can get an evaluation?
b) If a prior authorization is not needed, is there a cap of how many visits my child can receive in a year, or how many visits can my child receive before a prior authorization is required?
 
4) Do I have to meet the plan deductible before I receive any benefits, if so how high is my deductible and how much of it have I met this year?
 
5) Is there a max dollar amount or time amount my plan will pay for a certain service? (example: some plans will only pay for the equivalent of an hour occupational therapy session, while others will only pay up to a maximum dollar amount.)
 
6) What is your Eligible Charge/Fee Schedule for the following treatment codes:
Common occupational therapy CPT codes: 97167 (evaluation), 96125 (Standardized cognitive performance testing per hour, face to face time providing assessment, interpreting test results and preparing the report), 97530 (Therapeutic Activities, 15 minutes), 97112 (Neuromuscular Reeducation, 15 minutes) 97110 (Therapeutic Exercises, 15 minutes), 97535 (self care and activities of daily living training, 15 minutes)

I have an out of network prior authorization approved for occupational therapy services, can I use that?

Steps Ahead OT can provide a super bill with all your billing information to assist in your filing claims to your insurance company. If you qualify for reimbursement, it will be sent directly to you, not to Steps Ahead OT. Keep in mind, you will be charged directly by Steps Ahead OT for any services rendered, whether or not your insurance reimburses you. Steps Ahead OT is not responsible if your insurance denies the claim. Any disputes regarding reimbursement will be between you and your insurance company.