Frequently Asked Questions and Answers

Questions about Insurance

1. Do you accept insurance?

   Yes!!! We accept almost all insurances. We are considered out-of-network providers, which means that your insurance company will typically reimburse about 60 to 80% of our charges once your deductible has been met.

2. Why should I come out of network?
   • We are able to make medical care decisions based on individual patient needs and not on insurance company needs.
   • We are able to treat each patient as individuals, spend quality one-on-one time, and are able to go above and beyond to deliver the best quality care we can.
   • Our clinicians provided dedicated care and do not manage multiple patients during the same appointment time.
   • After our initial evaluation, we will provide you with a specific plan of care to meet your child and family functional goals.
   • You can expect to make noticeable progress in your within 3-5 visits or we will re-evaluate our strategy for more appropriate plan of care.
   • All of our clinicians have advanced certifications and most are working on their clinical doctorates.
   • We are dedicated to promoting best practices in pediatric therapy utilizing the most current evidence to support, modify, and continuously improve our intervention strategies.
   • Our care integrates prevention, fitness, learning through play and rehabilitation to support the individual child and family's needs.
   • We will maximize your potential and exceed your expectations.
3. What do you do to help patients file for reimbursement from their insurance provider?
   • We will authorize your visits with your insurance company, and provide you with a detailed outline of your benefits.
   • We will prepare and submit Universal Health Care Insurance Claim Forms for each visit.
   • You are welcome to pay us in full at the time of services, and have the insurance company reimburse you directly, or you may opt to pay us an estimated co-pay for your out-of-network benefits. If you choose the latter, we simply hold a credit card on file to cover any differences in estimated versus actual payments. Your privacy is completely protected in these transactions.
4. My Pediatrician (or insurance company) directed me someplace else, can I still come to you?
   • Yes!! Access to specific therapists cannot be limited by physicians or insurance companies.
   • Beware of insurance company recommendations. It is in their best financial interest to pay in-network rates, which usually amounts to 30 to 60 cents on the dollar. Insurance company profits (which are typically quite generous) depend on low reimbursement rates and patients not questioning the modified level of care.

Questions about Evaluation and Treatment

1. How long is an evaluation?

   Evaluations generally take 45-60 minutes. Come 15 minutes early with all the paper work filled out and either in hand or faxed ahead of time. This will give the therapist ample time to review your child's history and pick the most appropriate tests for the evaluation. It is important to be early in-case the therapist has questions.

2. How should we prepare?
   • Make sure your child is well rested and fed.
   • We try to make all testing and therapy play so you can prep your younger child by letting them know "we are going to play in a special place".
   • Your child should be in loose, easily removable clothing. For older clients make sure the affected area is easily exposes, i.e. shorts for a knee injury. Appropriate shoes for exercise are best though most of the evaluation will be done barefoot.
3. What happens after the evaluation?
   • Each child and therefore each evaluation is different. If the need for service is obvious treatment may be scheduled immediately. If there is a question on the best action the evaluating therapist may want to score any standardized tests given before offering a recommendation on a plan of actions.
   • Written evaluations take 1-2 weeks to be completed by the therapist depending on the complexity of the evaluation. You must sign a release of medical information form for reports to be sent to anyone other than the parents/caregiver.
4. What are treatment sessions like?
   • Sessions are usually 50 minutes in length to allow therapists time to write quick report on the session and speak with the parents.
   • It is the intention of all PEDI therapists to make treatment sessions fun and functional. There is often an initial period of adjustment for children to trust the therapist. During these periods the therapist will take things slow and utilize the parent to the best advantage to achieve functional goals.
   • Parent's are encouraged to be in the session so they can see what the therapist does and learn activities that can be done at home. For some children it works best for mom or dad to remain out of site for separation and full attention to the play activities.
5. How long will my child need therapy?

   Every child's therapeutic need is different. The therapist will continually discuss your child's progress and discharge plan. Discharge is based on the following:

   1. When goals are met.
   2. When a plateau for 2 months or more occurs.
   3. If low motivation for therapy over several sessions is seen.
   4. If parents wish to discontinue therapy.
   5. If the client fails to adhere to PEDI Center's attendance policy.
   
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