Please complete and return these forms prior to your child’s initial evaluation. This will allow us an opportunity to review your child’s history and adequately prepare for the evaluation.
Motor Screening Checklist and Referral for Occupational Therapy Services
Sensational Achievements is a private occupational therapy clinic. We provide services on a fee-for-service basis. We are an out-of-network provider for all insurance companies. Sensational Achievements will provide you with invoices and any requested insurance documentation to submit to your insurance company to assist you in getting reimbursement.
In Connecticut, you do not need a doctor’s referral to initiate occupational therapy services. However, depending on your insurance provider, you may be required to submit a treatment plan or prescription from your doctor for reimbursement purposes and to establish medical necessity. Services are typically deemed medically necessary if the diagnosed issues create functional limitations in your child’s ability to complete daily routines and skills such as dressing, eating, bathing, and toothbrushing or affect safety. School-based skills such as handwriting development are not considered medically necessary, and therefore not billable to insurance.
If you plan to submit to insurance for reimbursement, we recommend you find out the following information:
1) The diagnosis code if your child has any established (Diagnosis: Autism, PDD, low muscle tone, Cerebral Palsy, etc.)
2) If your insurance requires pre-authorization for occupational therapy visits
3) If there is a lifetime or per-calendar year limit on coverage for services or specific diagnoses
4) Documentation for insurance companies varies, but most require one or more of the following for reimbursement:
- Request for pre-authorization to approve visit
- Initial evaluation write-up and progress reports
- Doctor referral or prescription for therapy.
Some insurance companies require a doctor’s prescription to obtain pre-authorization for services. The client is responsible for letting Sensational Achievements know the specific documentation that is required and must provide any forms that the insurance company requests to be filled out by Sensational Achievements, LLC.
Should the insurance company deny a particular claim that should be covered under the client’s plan and the client is not successful in negotiating that claim with an insurance representative, it may be possible to appeal the denial through the client’s employer’s insurance liaison in Human Resources.
Here is a list of helpful resources to guide you through the insurance process: