COMMON QUESTIONS.

Sensational Kids Therapy is an out-of-network provider. However, we understand the difficulties families have with navigating the insurance world. As such, rather than providing families with a superbill each month to submit on their own, we have a third-party billing company who will take care of securing authorizations, submitting claims directly to your insurance company and follow-up on any denials so that every dollar is collected within the parameters of your plan. We know your time is valuable. We prioritize parents spending time with their child to maximize therapy efforts over dealing with their insurance company. In addition, being out-of-network allows us more flexibility in how we individualize treatment for your child and how we deliver therapeutic services. We can focus on what is most important to families rather than what the insurance company dictates as a covered service. Our billing company is a separate entity so that clinicians are not tasked with copious amounts of paperwork which distracts from intervention. Finally, discharge is determined by the therapist in collaboration with the family rather than when the insurance company dictates.

Our experience is that insurance companies are difficult to navigate for the average consumer. When we previously provided superbills to families, there were many denials due to not submitting claims in a timely manner and not obtaining the proper authorization ahead of starting therapy. Once a claim is denied, it takes many hours to sort out the reason for the denial and understand the process for resubmitting the claim. In many cases, claims are not eligible for resubmission if the authorization was not obtained ahead of those visits. Our therapists were spending time on the phone with a patient’s insurance company to try to sort out the issues which distracted from time spent on treatment planning and clinical communication with families. In 2016, we opted to partner with a billing company so that this would be a smoother process for families and to ensure they were entitled to the full eligibilities per their plan documents. Our billing company is a local company located in Lorton, Va. They are accessible by phone and email during East Coast business hours for any insurance or billing questions.

While we are not in network with any insurance companies, we do have a billing partner who will call your insurance company to gather information about your insurance benefits. They will contact you to explain your benefits and the billing process in more detail ahead of your first appointment. Our billing department will also obtain any necessary authorizations so that your child can be evaluated or receive ongoing therapy at our practice. Finally, each time your child is seen at our office they will submit claims electronically on your behalf. Any balance on your account will not be collected until after insurance processes each claim.

If an evaluation is recommended during our free intake call, Lisa or Shiraz will collect your insurance information and submit it to the third-party billing company. They will give your insurance company a call to verify your plan is active and learn what your out-of-network benefits entail. For example, the insurance company may provide information as to the number of visits allotted per year, your deductible amount and the percentage of the allowable amount that will be covered. This information will be communicated to you via email so that you have the plan details to review at your convenience.

Preparation for the evaluation largely depends on the child’s age and awareness about what is challenging for him/her. Elementary school aged children tend to be aware of where they are struggling. In this case, parents can explain that the evaluation will help identify why those particular activities are difficult and will help the evaluator design a program so that they become easier over time. Younger children may not have the awareness to make these connections. In this case, it is best to let children know that they will be going to a place to ‘play’ and that the evaluator will be asking them to do many different games with their big muscles and small muscles. Games will take place in a gym and at a table. Children of any age should be encouraged to try their best and follow instructions.

If an evaluation was performed at another practice, we will ask you to send the evaluation to us for review. We will first want to make sure that the evaluation is current within one calendar year. If not, we may ask for an updated progress report from the previous provider so that we have a current baseline and can establish a new plan of care. If the evaluation is current, we will then review it to make sure it is comprehensive for our purposes. If the evaluation is missing some critical components that we feel are needed, we may ask families or teachers to complete additional questionnaires or we may do some standardized testing during the first couple of therapy sessions. Occasionally, an evaluation may be too brief and we will recommend having our practice complete it.

Standardized testing is always the goal in an evaluation. However, some children lack the attention and/or motivation to participate in this format. Therapists will first attempt to engage the child using non-standardized play-based language to entice the child to engage with materials or perform a motor task. If the child still refuses, the therapist will move to a play-based approach and clinical observations will be made of the child’s performance. Sometimes, a child may need more warm-up time in order to fully participate. If this is the case and there is enough information from the evaluation to recommend therapy, the therapist can re-try testing in the therapy sessions once rapport has been fully established.

We typically receive referrals from pediatricians, teachers, and other healthcare professionals (speech language pathologists, psychologists, etc.). When parents call, we schedule approximately 20-30 minutes to talk about the reason for the referral as well as gather information about a child’s strengths and challenges. At that point, if we feel an evaluation is warranted, we will make a specific recommendation about the type of testing and let you know the specific cost associated with it.

OT evaluations and PT evaluations for children over the age of 1 include 60-90 minutes of direct observation in our outpatient clinic, a comprehensive written report and a follow-up meeting by phone or over Zoom to discuss the observations and recommendations. If direct therapy is indicated, families will have input into the plan of care and scheduling will be discussed. PT evaluations for babies 0-12 months also include a phone call prior to the in-person evaluation for the parent interview. This allows the therapist to focus on the baby immediately upon arrival and before they tire.

We have an open door policy when it comes to evaluations. Parents are welcome to sit in or wait in our waiting room. The decision is at the parent’s discretion and can be made in the moment. Parents know their children best. Some children are comforted by the presence of a parent and this is not a distraction. However, some children may be anxious by having an ‘audience’ and/or may exhibit negative behaviors that may not occur in the presence of the evaluator alone. If a parent chooses to sit in the session, we ask that he/she does not jump in and help his/her child with answers or physical assistance unless directed to do so by the evaluator. It is important that we see what your child can do independently.

The evaluation is the most important part of the therapy process. During the evaluation, our therapists will administer a variety of tests and measures along with clinical observations to help you understand your child’s strengths and challenges. In many instances, the findings from the evaluation help parents to understand some behaviors that their child may be displaying (refusals, avoidance, frustration, tantrums) that are impactful in their daily lives. Differences in motor skill development and sensory processing are often the culprits for a child self-limiting their activities or responding negatively when forced to participate. Our highly experienced therapists will provide a comprehensive, narrative report that is rich in clinical reasoning and that provides the basis for establishing a collaborative plan of care for therapy sessions.

In addition to providing a review of the session, therapists will always provide activities and recommendations for home programming. Communication is important so that therapists can continue to provide activities that are both therapeutic and motivating for children to do at home with their parents. Homework is never required, but most parents find that the activities are not a huge burden in terms of cost and time.

Per parent request (and with written permission), therapists can reach out to teachers via email or by phone. Through this ongoing communication, therapists and teachers can share information and come up with some ideas and strategies that are feasible for the classroom in order to help children experience more success. In addition, teachers may provide useful information about goal areas that can be addressed in therapy. It may be helpful to schedule a school visit so that the therapist can see the classroom first hand and observe how the child is functioning during more challenging parts of the day. This will allow the therapist to make more specific recommendations for the teaching team.

Occupational and physical therapy are closely related for the pediatric population. Both disciplines serve to increase independence and participation and look at the whole child. Physical therapists focus on improving the musculoskeletal system so that children can engage in age-appropriate activities which promote health, wellness and socialization. Occupational therapists focus on improving function so that children can participate in activities related to school, self-care, and leisure.

Early intervention services and school-based therapy services fall under the educational model, whereas therapy in the private sector falls under the medical model. Therefore, educationally-based therapists are restricted to working only on goals established in the IFSP or IEP process. The goals are based on what is needed for a child to be independent in the school setting, typically fine and visual motor skills. Private therapists are free to use a variety of frames of reference to guide treatment with the goal being to improve outcomes in any area that is falling outside of the typical range.

The duration of therapy varies for every child. This largely depends on test scores, the number of areas being addressed, frequency of services, and carryover at home and school. Children also vary in their motivation to participate in therapeutic activities in the clinic, at home, and at school. The goal is always to help children move out of therapy and into age-appropriate activities with their peers as soon as possible.