Going In-Network for Therapies? Here’s a Cheat Sheet

Changing health plans? Out-of-network deductible got you down? New medically based service recommended for your child? It may be time to research in-network options for pediatric physical, occupational, or speech therapy services.

But where do we start? Do we ask for recommendations or look through the list of in-network providers? And when we have the list, how do we pick a provider appropriate to our child’s needs? Undivided Director of Health Plan Advocacy Leslie Lobel explains that parents can start from either end of the search — gathering names from trusted sources or getting a list of in-network providers from insurance:

Don’t despair when you download the network list — they are not written to be family-friendly. Take a moment to identify and weed out the clinics that are listed over and over with different therapist’s names.

Once you have your list narrowed down, there is some information you’ll want to research with the listed providers to determine a network provider’s suitability to address your child’s medical needs as prescribed by the referring physician.

So grab a pen and ask the following questions:

• What is the provider’s current network status for your plan?
• What is the duration of sessions (30 or 60 minutes) that the provider can offer for your plan’s contracted rate?
• What is the level of training of the available evaluating and treating therapist? (See listing of acronyms below*)
• What is the experience of available therapists in the specific areas of need that have been identified for your child?
• What is the wait time for the initial session and the availability of suitable ongoing therapy time(s)?
• Will the provider generate a written evaluation with specific treatment goals?
• What is the contract rate due per session to meet the annual deductible, and the copay once that deductible is met?
• If your child will have multiple sessions per week, will all sessions be scheduled with the same provider?

You should always seek the recommendation of your child’s care team before making any final decisions as to a provider for either in- or out-of-network options. We hope this list can serve as an informational aid to help you balance your child’s specific clinical needs with funding considerations of working in-network as opposed to out-of-network. As always, if we can help in any way, please let us know.

Here are some acronyms to keep in mind:

• SLP (Speech Language Pathologist) or SLPA (Speech Language Pathology Assistant)
• OTR (Registered Occupational Therapist or COTA (Certified OT Assistant)
• RPT (Registered Physical Therapist or PTA (Physical Therapy Assistant)

You can learn more in our therapy glossary.