If your baby received therapy in the NICU, your discharge plan may recommend that the therapy continues after you take your baby home. Your first step should be to ask the NICU social worker for help with setting this up.
ECI serves infants and toddlers from birth to 3 years of age. Contact your local ECI program and request an evaluation to see if your baby is eligible to receive therapy services through their program. If not, it’s probably time to find a private therapist.
Start by asking your child’s pediatrician for a recommendation. Many doctors and hospitals have developed positive working relationships with private therapy companies. If the hospital social worker gave you a list of therapists or companies to contact, ask your doctor if he is familiar with them, and which he would recommend.
If you are looking for a private therapist on your own, you should know that many types of therapy services require a doctor’s order or referral. If so, the therapy provider will ask for that.
If you search online for a pediatric therapist, make sure the therapist or clinic you are considering has training and experience in the area of your child’s needs. For example, not all speech-language pathologists know how to treat feeding/swallowing disorders. Be sure to describe your child’s needs when you make the first contact.
It is important to know that every type of therapist has a license awarded by a licensing board. These licensing boards create rules that the therapist must follow. If you have a complaint about a therapist, you can contact the licensing board about it.
Private insurance or Medicaid case managers may be able to help you locate "in network" therapists that are covered by your plan.
In most cases, insurance can be billed for:
- Hospital-based therapy
- Home health therapy
- Private therapy
- Therapy provided by ECI
It is important to know that many insurance companies will not pay for duplicate services. For example, since some ECI programs bill insurance, you will not be able to use your insurance coverage for private therapy and the ECI therapy services at the same time. However, your child can receive school-based therapy and private therapy at the same time because school-based services do not bill insurance.
Many private therapists accept insurance and/or Medicaid. It is very important that you ask your insurance company the following questions:
- Does your plan cover the type of therapy that is recommended?
- Does the service being requested require doctor’s orders?
- If so, ask the following questions:
- Are there certain requirements that your child must meet for them to pay for the service? For example, some insurance companies will only cover “congenital” disorders, meaning that your child has had the need since birth.
- Are services covered if provided in a clinic, home, or both? Some insurance companies will only approve and pay for services in a clinic
- What is the percentage or amount that will be covered?
- What will your copay be?
- Do you have a deductible that needs to be met before they pay?
If your insurance covers less than 100%, you should ask the private therapy company about their policy for payment. Also ask about the cost of each session if your insurance will not cover part or all of a session.
Private therapy can occur in a clinic, or in your home. There are many things to think about when deciding where your child should have therapy:
- Will insurance cover the location you are considering?
- Which place would provide the best location for your child’s therapy? Clinics usually have more materials to work with, but your home may be where your child feels more comfortable and participates more during therapy sessions.
- Transportation: you may have to take your child to the clinic for private therapy, while a home health therapist will come to your home.
Your child’s ability to be moved or willingness to leave home is also a factor to consider.