Does Health Insurance Cover Occupational Therapy?
Most health insurance plans cover occupational therapy, although the exact type and amount of coverage depends on your specific healthcare policy. The American Occupational Therapy Association reports that the Affordable Care Act, which was signed into law in 2010, put occupational therapy into the mandatory benefits package. Your insurance company, however, may still have strict limits on the types of programs or overall limits on how much it will cover.
Occupational therapy is a type of treatment that helps people learn skills to become independent. The overall goal is enhance a person’s health and overall well-being by helping individuals perform activities so they can more completely participate in their lives.
Who needs occupational therapy?
Occupational therapy can be beneficial for both adults and children, KidsHealth.org says. Because treatment focuses on helping people achieve independence, it can not only enhance their physical health and performance capacity, but it can also help boost their self-esteem.
Adults who may benefit from occupational therapy include those who were injured, disabled, or otherwise left unable to perform the daily tasks they used to do with ease. Victims of spinal or brain injuries typically make the list of prime candidates, as do those suffering from other severe trauma or debilitating conditions such as arthritis.
Children who may benefit include those who were also injured or disabled, either from birth defects and birth injuries or later incidents. Children who suffer from physical or mental issues can also benefit from OT.
Specific physical ailments include traumatic injuries, juvenile rheumatoid arthritis, conditions brought on after surgeries, amputations, and chronic illnesses such as cerebral palsy and multiple sclerosis. Spina bifida, cancer, hand injuries, broken bones, and burns also make the list of physical conditions that may be improved through occupational therapy.
Mental conditions OT can help include learning problems and a number of disorders that range from learning disorders to those that interfere with sensory processing. Developmental delays and disorders, autism, and behavioral or mental problems can also be improved with occupational therapy.
How can occupational therapists help?
Occupational therapists can help patients with motor skills, hand-eye coordination, and learning or re-leaning basic tasks through a series of repetitive activities. Motor skills and hand-eye coordination can be particularly vital for kids, enhancing their abilities to develop handwriting skills, grasp objects, and improve their sports and play performance.
Basic tasks can include getting dressed, bathing, and performing other daily activities that a person would otherwise need assistance with. Therapists may do this by illustrating techniques people can use to perform a task, adapting the environment, or a combination of both. Environmental adaptations can include equipment to help make daily tasks easier, such as splints, bathing aids, or other specialized tools,
In the mental and behavioral category, therapists can help people learn how to better channel their emotions. Anger management is a prime example, offering people outlets other than violent reactions. Therapists may teach people how to channel their anger in a more positive way, with activities that include intense exercise or using art or writing to purge their rage.
What’s the difference between occupational therapy and physical therapy?
The main difference between occupational therapy and physical therapy is its overall goal. Occupational therapists aim to improve the overall quality of life and well-being, while physical therapists concentrate on improving a person’s mobility skills.
While both types of therapy may indeed improve a person’s quality of life, occupational therapy focuses more on achieving independence through the use of available equipment and environmental modifications. Physical therapy, on the other hand, focuses more on education and training to improve movement. The two may overlap, especially in the case of injury rehabilitation, and both may be covered to some extent by your health insurance plan.
What are some stipulations that may come with occupational therapy coverage?
Your insurance company may put limits on the number of visits or maximum amount of coverage it will provide for occupational therapy. It can also require that the therapy is deemed medically necessary by a healthcare professional or even include a referral from your primary care physician or other provider.
Some insurance companies may only cover occupational therapy for rehabilitation after injuries, while others may extend to include OT to help developmental and learning disorders in children. The company may also only cover OT as a short-term therapeutic solution that lasts a set number of sessions or months.
It may also exclude occupational therapy related to certain tasks the company does not see as a necessity of daily living. One example may be driving a car, which may not technically be as vital to survival as a task such as feeding yourself.
Your healthcare provider may also need to submit a detailed plan of action as well as ongoing progress reports to your company to ensure your OT is covered. Plan details would include things like your diagnosis, evidence that OT is a medical necessity, your OT plan’s overall goals, and an estimate of when those goals are expected to be reached.