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Beginner Guide

Therapy Funding & Insurance 101

Copays? Deductibles? Prior authorization? This plain‑language guide helps you verify benefits, track approvals, and reduce surprise bills—so you can focus on care.

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Key terms (fast)

Copay

Fixed amount you pay per visit (e.g., $20).

Deductible

Amount you pay each year before insurance starts paying.

Coinsurance

Percentage you pay after deductible (e.g., 20%).

Prior authorization

Approval from your plan before therapy visits will be covered.

Referral

A note from your PCP saying therapy is medically necessary.

In‑network

Provider has a contract with your plan—usually lower cost.

How to verify benefits (script)

  1. Call the number on your card and ask for benefits for Outpatient Occupational Therapy.
  2. Write down copay, deductible, coinsurance, visit limits, and whether prior authorization or a referral is required.
  3. Ask if the clinic is in‑network and how to submit out‑of‑network claims if needed.
  4. Request and save a reference number for the call.

Ways to lower costs

  • Use in‑network providers when possible.
  • Ask clinics about payment plans, sliding‑scale rates, or cash discounts.
  • Use HSA/FSA funds for eligible expenses.
  • Look for grants or state disability waivers; ask your clinic’s social worker for leads.
  • Group sessions or parent coaching blocks can be more affordable.

Track approvals

Keep a simple table of authorization numbers, start/end dates, and the number of approved visits. Renew authorizations before they expire.

Auth # | Start | End | Visits approved | Visits used | Notes

FAQ

What if insurance denies a claim?
Ask the clinic to review the denial reason and help submit corrected claims or an appeal. Keep copies of all notes and reference numbers.
Can I use private therapy if school says we don’t qualify?
Yes. School services are educational access; private therapy follows medical criteria. Families often use both.