Questions to Ask Your Insurance Company About Occupational Therapy

  1. Does my insurance plan cover Occupational Therapy?
  2. Do I have to get a letter from a licensed medical provider (Physician or Physician’s Assistant) to state this is medically necessary?
  3. Do I need to send the letter from the medical provider before seeing the Occupational Therapy provider OR can it be submitted with the first bill?
  4. Is a diagnostic code required for reimbursement?
  5. What is the reimbursement scale for Occupational Therapy?
  6. What is the deductible on the plan? $__________ (amount)
  7. Is there any deductible left to meet this year?
    $__________ (amount)
  8. Is there a limit on the total amount that can be paid out each year? $__________ (amount)
  9. Is an Occupational Therapy Evaluation covered by my insurance? $__________(amount)
  10. How many Occupational Therapy sessions will be covered by insurance in total per year? $__________(amount)
  11. Does my coverage extend to the services of a non-network provider?
  12. What is the maximum covered cost per Occupational Therapy session? $__________(amount)
  13. What is the Co-payment per Occupational Therapy session? 
  14. Must we be referred for Occupational Therapy by a medical doctor or is an OTR sufficient?
  15. If we are already in Occupational Therapy with another provider, what is my remaining coverage for Occupational Therapy this year? $__________(amount)
  16. Does my insurance cover the following codes:


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