Frequently Asked Questions
About Therpy

What Should I Do to Get Started With Therapy?

After receiving a referral to OT Connection, or even if you are seeking out therapy on your own accord, please contact our office to schedule your first appointment. Our friendly office staff will do their best to answer all of your questions, and will schedule your first appointment, which is most typically an evaluation. Prior to this appointment, you will be directed to our website to complete our New Client Packet. This packet will provide us with important information regarding your child’s growth and development, and allow you to share with us your concerns related to therapy services. You may also have additional informational forms to complete which may be mailed to you if you suspect your child may have sensory processing difficulties.

Our office staff will obtain your health insurance information and check your benefits for therapy prior to your first appointment.

Your First Visit to the Clinic

Please have all your paperwork completed, and arrive 10-15 minutes prior to your appointment time to check in and ensure all necessary forms are completed. Please bring your insurance card and prescription for therapy services from your child’s physician. If you do not have a prescription for therapy, don’t worry, we can assist you with this.

We schedule 60-90 minutes of a therapist’s time for an evaluation, although the evaluation process may be completed in less time. It will depend on your child’s ability to participate, standardized testing and clinical observations required, etc. You are required to be present with your child for the first portion of the evaluation in order to discuss your present concerns and your child’s developmental history information. Based on this information, all necessary testing will be administered. Following this discussion, we will take your child back to the therapy rooms for their testing. We have found that many times children do not perform as well with a parent present, so we typically request that all parents remain in the waiting room for the remainder of the evaluation. If for any reason you feel uncomfortable with this, you of course may remain present for the duration of the assessment.

Upon completion of the assessment, the therapist will review the results of the tests, discuss areas of suspected delay, and make recommendations regarding therapy. If therapy is recommended, you may schedule future therapy sessions at this time. More specific results from the testing will be available within 1 week after your child’s evaluation in order for the therapist to accurately score and report on all testing material. A plan of care and proposed goals will be included in the evaluation report. We strongly encourage all parents/care-givers to share with us their personal goals they would like to see their child achieve as well, so that these may be added to the evaluation report.

Scheduled Appointments for Therapy

We request that all patients arrive at the clinic 5-10 minutes in advance of their scheduled therapy time to allow for a smooth transition. We also request that all co-pays, co-insurance, and deductibles be paid at this time. Charges for all therapy services which are not covered by your insurance company, or for individuals without health insurance coverage, are to be collected at the time of service.

Therapy sessions are 50 minutes in length with the next 5 minutes set aside for parent education/discussion of progress in therapy that day. During your child's therapy session, most of our parents remain in the waiting room. We again find that some children perform better without a parent present. On occasion, or on request, parents may observe portions of or all of the therapy session.

If you decide to leave the clinic during your child's' therapy session, we request that you provide a contact number where you can be reached in case of emergency, illness, etc., and that you return to the clinic 15 minutes before the hour.

How Long Will My Child Receive Therapy Services?

This question will be more easily answered once your child’s evaluation is complete. If therapy services are recommended, a frequency and tentative time line will be established, along with a plan of care, and goals to be achieved on both a short-term and long-term basis. Most of our patients begin therapy twice weekly for a period of 6-12 months depending on severity of needs. Children continue at their recommended frequency for as long as it is needed. As long as your child is making progress towards their goals, therapy will continue.

When Will Therapy Services End?

Therapy services are recommended to cease for different reasons. Occasionally, a child who has a long-term need with more severe deficits, may need to “take a break” from therapy. The child may experience frustration with their delays and overall difficulties with therapy activities, choose to take a little time off, and then resume therapy after a period of weeks/months. We also feel it is important to assess whether a child is able to maintain their level of function and continue to progress without direct services after a period of time in therapy. Therapy services are discharged when the child has met all their goals, achieved age level skills, or is no longer benefiting from direct service. We encourage all children and family members to be actively involved with all parts of the therapy process, including setting goals, establishing a plan of care, carrying out recommended home exercise program activities, and with discharge planning.

Health Insurance

OT Connection is an "in network" provider for many major health insurance plans and will file claims on your behalf. The insurance companies we are in-network with are as follows:

• Blue Cross Blue Shield
• Tricare
• Great West
• HealthSmart
• Humana
• Medicaid
• Superior Healthplan
• PHCS

Health Insurance Coverage: What you need to know

1. Be Well Informed of Your Coverage

Your health insurance plan may provide benefits for Occupational, Physical or Speech therapy, but, there are often limitations and/or specific exclusions for this coverage. These may include, but are not limited to:

• Exclusions for diagnoses related to developmental delay or for services being educationally based.
• Speech-Language Therapy services for children under three years of age only.
• Therapy service coverage only when therapy is required due to accident, injury, or other congenital condition.
• A limitation of the number of therapy visits per year, number of therapy visits per discipline (i.e. 40 visits for OT, 60 visits for ST, etc.), or per authorization.
• Additionally, some plans may require a referral and/or “pre-authorization” for treatment. In order for you to receive therapy services, they must be approved by your carrier in advance. This may be required once for the duration your child receives therapy, once per year, or once per authorized number of sessions. (i.e. every 20 visits a new authorization may be required)

2. Document Your Actions

• We strongly encourage parents to take written notes during all discussions they have with their insurance provider, including the date and time, and name of the representative you speak with. Having this information is crucial if there is later a dispute over coverage.
• Please understand that when an insurance company representative provides you with a quote of benefits, it not considered an absolute guarantee of coverage or payment for services rendered.
• Always ask for any limitations or exclusions to the benefits or coverage. Ask the representative for any “specific” exclusions, such as a limitation for age, diagnosis, etc. When you are obtaining coverage information for multiple services, determine whether limitations and/or exclusions apply to each service or to multiple services. (OT/PT/ST)
• Request current information on what your deductible and out of pocket maximum is, how much of the deductible you have met to date, and your coverage for the services you are seeking once your out of pocket maximum has been met.
• Ask the representative to repeat back to you the information you have received to avoid any confusion.

3. Look for potential problems early – Read your EOB letters thoroughly

• An Explanation Of Benefits (EOB) is created for each claim submitted to your insurance company. The EOB will be sent to you by mail and is your detailed explanation of the services you have received; what you were charged, and how much you owe.
• You and your service provider/therapy clinic will receive identical information, typically 30-45 days after a visit.
• It frequently takes some time before payment issues are identified by you, or your provider. If you think you see a problem, contact our therapy clinic’s billing administrator / office manager immediately. You are ultimately responsible for any services not paid by your insurance company
• For any specific questions regarding your coverage, access your employer’s benefit coordinator or human resources department. These departments manage your health plan and should be your primary resource should you not understand your coverage.

What should I do if therapy services are not covered or denied?

• Check with your employer’s benefit coordinator to see if they have any additional reimbursement programs for either the therapy services you are seeking or the diagnosis/condition being treated. (IBM is one local company that offers a special assistance program, but there are additional companies as well.)

ADDITIONAL QUESTIONS

Question: Can I bring my other children to the evaluation?

Answer: We would prefer that you make arrangements for child-care for siblings for your child’s first appointment / evaluation at the clinic. We will need your undivided attention as we gather developmental history and try to get a clear picture of your child and your concerns for therapy. Having other children present can be distracting, and we are unable to allow any children to be left unsupervised, even in the waiting room for a short period of time. We understand that sometimes, child-care is just not feasible, so in this case, we will just do the best we can to complete the initial interview.

Question: My child is school-aged is it possible for me to get an after school appointment?

Answer: Absolutely, however, since many of our children are school-aged, parents frequently request an appointment after school hours. Unfortunately, each therapist has only a limited number of appointment slots available that satisfy this condition. Therefore, we ask for your understanding when we can not satisfy your request. If an after school appointment remains a high priority for you, please let us know and we will let you know when an opening develops.

Question: I have been suspecting for a long time that my eleven year old daughter has ADD...I am pretty desperate to help her. What would you suggest?

Answer: You should start with a general pediatrician visit - check out vision, hearing, diet, general health. Next, request an Occupational Therapy evaluation to assess for potential areas of need. We find that up to 60% of children are misdiagnosed with ADHD/ADD, and that most of the kids who have attention deficits benefit in some way from Occupational Therapy. We can usually find out through a thorough evaluation of a child’s sensory systems if Sensory Integration is at the root of their difficulties. We work with several doctors in the area known for their ability to help children like your daughter and can refer you to a specialist.

Question: How do I get a professional diagnosis of Aspergers Syndrome or Autism?

Answer: A medical diagnosis needs to come from someone with skills and training in developmental disabilities. This can include developmental pediatricians, neurologists, and psychologists. Occupational Therapists (OTs) can aid in treatment before or after a diagnosis is determined. However, from an occupational therapy point of view, a diagnosis isn't necessary--we focus on helping a child function with their current conditions regardless of diagnosis. A diagnosis is helpful (and may be necessary) for obtaining school special education services or for your medical insurance to provide or pay for treatment.

Question: I am pretty certain our 3 year old son has some degree of sensory integration disorder. A few people over the last year have mentioned, after spending time with him, that he may have a sensory disorder. I recently picked up a book on Sensory Integration and what I have read so far sounds a lot like J. We have Tricare Insurance. Do you know if we need to get a referral from our Primary Care doctor before seeing you? I would greatly appreciate any information you can send my way.

Answer: I would greatly recommend you call us at the clinic (512) 251-3230 with your current concerns. We can facilitate any referrals or prescriptions needed from your son’s pediatrician. I want you to know that you’re not alone. Sensory Processing Disorders are more common that most people know, and doctors aren’t always good at identifying it. I have worked with children long enough to know early identification greatly increases the success rate of treatment. Three-year-old children are excellent candidates for therapy and usually do quite well. There are many ways to help you understand his behavior, and strategies we can teach you both to help him to control himself, and become more successful in his environment. I look forward to meeting you and your son soon.

Question: Do you have any experience working with older kids, particularly those that may have Aspergers Syndrome?

Answer: Yes, we have lots of experience working with older children. For some reason, children are frequently diagnosed with Aspergers after age 8 rather than before it. This may in part have to do with the type of thinking and organization that we expect of older children. These children usually do “OK” with concrete reasoning and simple organization, but generally have more difficulties with abstract thought, higher level organization, problem solving, and social relationships. Remember that the earlier we can identify the true nature of his problems, the easier it is to offer solutions.

Your local school district may have autism resources, so that is also an option you should investigate. There is a significant amount of paperwork, headaches, and time in obtaining these assessments for special education services, but it can be done. School related Occupational Therapy and Speech-Language Therapy provide services based on your child’s “educational” needs only. This frequently is not sufficient in order for you child to progress at an appropriate or desired rate and to address all of your child’s areas of need. Out-patient therapy services, in addition to school based therapy, is highly recommended. Also keep in mind that the schools frequently do not provide services during the summer.

Question: If my child is has ADD (or ADHD), will Sensory Integration therapy help?

Answer: Yes. Studies show that 40% to 60% of individuals diagnosed with ADD or ADHD also have sensory processing disorder (SPD). This leads some to speculate that perhaps some children are being misdiagnosed. We conduct a comprehensive assessment to determine if SPD is present and treat it appropriately. Also, we can teach your child self regulation skills that may help them learn to control their behavior better.