When parents first begin to research therapies for their children, the costs can seem overwhelming. Not only for the therapy sessions themselves, but also for ancillary costs such as time off work and transportation. Let’s take a look at what therapies cost with and without insurance.
For a look at what pediatric therapies there are, how they differ, and what each is treatment for, visit these posts: Physical Therapy and Occupational Therapy are Actually Different: Find Out if your Child Needs Both and also How to Know if your child could Benefit from Speech Therapy.
With any potential therapy, always research the provider/clinic for quality and accessibility and get the costs up-front prior to going to that initial assessment appointment. If you have insurance which covers therapy, call the insurer and ask if the provider you are wanting your child to be seen by is covered and in-network. Covered and in-network are not synonymous. A provider may be covered, but be out-of-network in which case you will pay a higher cost. Next, inquire about copay or co-insurance and deductible amounts. Ask whether the deductible has already been met, and, if not, what amount is left. Finally, ask about the annual limits on the number of therapy visits. These limits vary widely from plan to plan. A quick call and a small bit of research can help prevent a large and unexpected bill!
The cost of therapy, along with our collective blood pressure and nearly everything else, has went up over the last few years. But, as someone who has undergone many sessions of both physical therapy (PT) and occupational therapy (OT), I can attest to their effectiveness and am so glad I had them. We hope that quality therapy provides excellent outcomes for your little ones as well.
Costs with insurance
Differing insurances and differing insurance plans make costs for physical therapy sessions wide-ranging. What’s the difference between insurances and plans you might ask? Insurance is the general term used for a company that offers plans. Blue Cross Blue Shield, for example, is an insurance company that offers plans via employers, Individual and Family plans on the Health Insurance Marketplace, and Medicaid and Medicare plans.
Insurers nowadays most often have an online portal to view policy documents. The Plan Summaries section details common services that are covered and what those services will cost, whereas the Plan Documents contains all of the covered services. Below is an excerpt of an actual plan document from Aetna:
ST - Speech therapy
In this example the policyholder would be able to have a maximum of 60 visits per year total for all three therapies. Each visit would cost a $35 co-pay (regardless of type of therapy) and this person would have no deductible.
Location, therapists’ experience/degrees, and more can all factor into the cost of a session. Insurance plans with high deductible/low premiums are going to cost more up-front for sessions due to needing to meet that deductible if it hasn’t already been met.
Plans with copays for sessions are normally going to cost less than those with coinsurance. Co-pays typically are between $30/35 – $50/75 per visit. Coinsurance normally is 20 – 40%. This means that you will pay this percentage of the bill and your insurance will pay the rest (after you have met your deductible). Co-pays/co-insurance amounts are normally the same across each modality of therapy.
Costs without insurance
Many therapy clinics have sliding-scale payment fees, based on income, for those without insurance coverage (Therapy FAQs). However, clinics likely will not offer this information unless asked for it. So, be sure to ask about sliding-scale payments or any discounts the clinic may offer.
The chart below is merely a guide to quickly get an idea of the therapy costs. Please, do yourself the courtesy of calling and requesting price information prior to any appointments.
Co-pay / Co-insurance
$20-55 / 10-40%
$20-55 / 10-40%
$20-55 / 10-40%
$20-55 / 10-40%
It would be fantastic if our readers tell us about their experiences with their insurances past and/or present. Tell us which plans offer great coverage, which ones to stay away from, which ones are exorbitantly high, etc. Soon we’ll take a deeper dive into health insurance plans in the Indy area.
1. Hassan, M. PT, DPT (October 20, 2022) Is Physical Therapy Covered By Insurance? Very Well Health. https://www.verywellhealth.com/physical-therapy-cost-5194917
2. Therapy Faqs. How Much Does Therapy Cost? Good Therapy Blog. https://www.goodtherapy.org/blog/faq/how-much-does-therapy-cost
3. Physical Therapy Cost. Costhelperhealth. https://health.costhelper.com/physical-therapist.html