Insurance can feel overwhelming—especially when you’re trying to make sure your child gets the speech or occupational therapy they need. We want to take a moment to clearly explain some common insurance terms and how they apply to your visits in our office, so there are no surprises along the way.
What Is a Deductible?
A deductible is the amount of money you are responsible for paying out of pocket each year before your insurance company begins paying for services. Even if you pay for these visits, if they are applied to your deductible, they are also applied to your visit count.
Think of it as a threshold:
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Until your deductible is met, you pay for therapy services
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Once it’s met, your insurance may begin covering part (or sometimes all) of the cost, depending on your plan
Individual vs. Family Deductibles
Most plans have two deductibles:
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Individual deductible: applies to one person on the plan
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Family deductible: the total amount that must be met across all family members
Payments made for your child’s therapy may count toward both, depending on your insurance plan. This is something your insurance company can clarify for you.
What Are Copays?
A copay is a set dollar amount you pay for each visit (for example, $30 per session), regardless of the total cost of the service.
Copays usually apply after your deductible is met—but every plan is different, so it’s always best to double-check.
What Is Coinsurance?
Coinsurance is when you and your insurance company split the cost of care after the deductible is met.
For example:
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Insurance pays 80%
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You pay 20%
That 20% is your coinsurance responsibility.
How Billing Works in Our Therapy Office
If your visit is applied toward your deductible, you will receive an invoice as soon as insurance processes the claim.
Each invoice includes an easy click-to-pay option so you can take care of it quickly and securely.
Because therapy sessions happen weekly, unpaid invoices can add up fast. Staying current helps prevent balances from building and ensures your child can continue therapy without interruption. You may receive a phone call if we have sent the invoice a few times or if several invoices have processed at once to ensure you see the total and to eliminate surprise balances.
We’re Flexible—and We’re Human
If you’re experiencing financial challenges and want your child to continue therapy, please talk to us. We are flexible providers and will always do our best to work with you on a plan when possible. Communication is key.
Questions About Your Coverage? Go Straight to the Source
For the most accurate information about your deductible, copays, or coinsurance:
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Call the 800 number on the back of your insurance card, or
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Log into your insurance member portal
When you call, it can help to reference these commonly used CPT codes:
Speech Therapy CPT Codes (commonly used):
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92507
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92526
Occupational Therapy CPT Codes (commonly used):
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97530
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97112
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97535
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97110
You can ask:
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What is my individual deductible?
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What is my family deductible?
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How much has been met so far?
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Do these CPT codes apply to my deductible, copay, or coinsurance?
We’re Here to Support You
Our goal is to support your child’s progress while also being transparent and supportive with families. If you ever have questions about billing, invoices, or insurance terms—please reach out. We’re happy to help you navigate it.
You focus on your child. We’ll help with the rest. 💙