Is Therapy Covered by Insurance?

  1. I will inform the patient up front that we do start every VT patient like a cash paying patient.
  2. If we are going to file for their visits I will tell them we will start therapy and once the patient’s 1st session has occurred we will file and within about a month we should know whether or not any amount of the sessions will be covered.
  3. This is also based on whether or not the individual has a deductible that needs to be met, etc.
  4. Also as of right now I am under the assumption that the only patients who are candidates to have a chance at getting therapy covered are the ones who have coverage with BCBS or Cigna and with a Convergence Insufficiency diagnosis. If the patient does not fall under this specific category, I will usually just go ahead and tell them it will be cash pay. They may want to file to insurance on their own and if they ask that I do let them know we can provide the billing sheets for each week's session, but that we will not file in our office.
  5. Therapy sessions are $140 total and the only amount of that $140 that is billable to insurance is a $45 amount. $85 is always out of pocket.
Dr. McBryar cartoon
Short version is therapy is only covered under a few certain plans with very specific diagnoses and a test claim has to be run (on session 1) before we know anything. If the patient asks if they can know beforehand if therapy will be covered it is a very lengthy in depth process that typically doesn’t help with any type of coverage.

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