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Forum -> Inquiries & Offers -> Lakewood, Toms River & Jackson related Inquiries
OT for my 4 yr old ds



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amother
OP


 

Post Tue, Sep 24 2019, 9:06 pm
Hi my doctor gave me a referral for my 4 yr old ds to be evaluated for OT. She mentioned children’s specialized in Toms River. It’s pretty far from my house if I would need to bring him there once or twice a week for therapy. I’m on amerigroup. Which local agencys are good that take my insurance?
Also let’s say he gets evaluated by one place, can I get the therapy from another place?
Are there OT’s that would come to my house?
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emi1812




 
 
    
 

Post Thu, Nov 14 2019, 12:01 am
The only therapy you can get locally with Amerigroup is from childrens specialized. The therapists there are very hit and miss. Some are good, some not so good. Insurance (all insurance) only covers a very limited amount of visits, and your son will be discharged after several weeks (the sessions will get used up quicker with 2x/weekly sessions). As for a home based therapist, you won’t get a therapist who comes to the home unless it’s early intervention for a child under age 3.
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amother
OP


 

Post Thu, Nov 14 2019, 9:28 am
thank you for the info
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amother
Maroon


 

Post Thu, Nov 14 2019, 9:37 am
Your son will only be discharged after several weeks if he met the goal. In my experience, the goals you devise together are more life skills goals than solely academic goals, but of course there is overlap - because for most children their "job" is to be a student. My child had 2x/week OT there last year for 6 months. Also you can do a peer-to-peer if you feel that it should be extended. That's when your doctor talks to the insurance co and basically convinces them that you need more. There's a small window of opportunity, but if you meet the criteria, it can be successful. It was for us! We got another 9 weeks of speech therapy after they wanted to terminate.

If you go that route, when you schedule, don't be afraid to ask a lot of questions - how long the person has been practicing, how long they have been at Children's, etc. You are your child's best advocate!
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emi1812




 
 
    
 

Post Thu, Nov 14 2019, 10:34 am
With insurance, they will only cover therapy if it’s for medical (not developmental) reasons. As for getting the insurance to cover more sessions, it really depends on the insurance company you’re dealing with. Oftentimes they’ll agree, then change their mind when the insurance billing is submitted. Some insurances are more stingy and have a hard and fast set limit to sessions, and will refuse to cover more. The only way to find out is to try. It doesn’t hurt to try and see if you can get insurance to cover more!
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amother
Maroon


 

Post Thu, Nov 14 2019, 12:00 pm
Sorry emi, I just wanted to clarify a statement, mostly because I was so clueless when I started out and there's a lot of misinformation out there, and I'd like to help out if I can. I was discouraged from going through my insurance from statements like this, and I lost out because my child really was eligible..

Insurance absolutely does cover OT for developmental problems but there is a threshold where under a certain percentage of delay they will cover, and if you are over the percentage that delay is considered not medically necessary. (Although, of course, the delay is still present and may negatively impact a child - its just not enough to warrant coverage) But the delay itself can definitely be developmental in nature.
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emi1812




 
 
    
 

Post Thu, Nov 14 2019, 2:02 pm
Amaroon, perhaps that’s the case w/ your insurance, but that’s not an across the board universal policy with all insurances at all. I wish that was true, but unfortunately a lot of insurances do not do what your policy does. Mine certainly doesn’t. Neither does my husbands. Our plans are considered to be “great”, but they won’t cover any more than 15-30 visits per calendar year. Btw, I did not discourage anyone from trying. On the contrary, if you go back and re-read my comment, I actually encouraged others to try anyway because we never know what may happen and things might work out!
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amother
Linen


 

Post Thu, Nov 14 2019, 7:13 pm
Just be aware that there is quite a wait right now. I called recently to schedule an ot eval for my child and they are scheduling in February.
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amother
Gray


 

Post Thu, Nov 14 2019, 8:46 pm
There's no blanket rule, but in general insurance companies have been really shifting to deny services for anything they don't consider medical necessity. As others have said, it doesn't hurt to try getting it covered before paying out of pocket.
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amother
Pink


 

Post Thu, Nov 14 2019, 9:07 pm
I’ve used Bruchi Greenspan in Lakewood and seen great results with my child. She’s private practice but cheaper than most other private OTs and so honest. Won’t tell you to come more than necessary. 732-955-4841
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amother
OP


 

Post Thu, Nov 14 2019, 10:51 pm
Thank you everyone!
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