You are getting evaluated for therapy (speech, feeding, OT, PT, CBT) and you pick the first availability with a company that takes your insurance. How do you know if their evaluation is correct for how many sessions are needed? Maybe they just want you to come back over and over. How can you guarantee they will help your family? What if you don’t feel like the therapist is a good fit? I’m going to address these questions, asked by families I have worked with, by giving you my top 5 questions to ask during or after a therapy evaluation!
1. How do you set goals for my child and document progress? This is very important because there are specifics that are sent to the insurance company to document need and coverage, but what about your family’s goals? Are you able to incorporate those? Not to mention, you want to know how to determine if the therapy is working and helping your child progress. Which leads me to the 2nd question . . .
2. How long do you think my child will need therapy and what has to be met to determine when they are done? You do not want to have to go to therapy forever (unless your child’s diagnosis warrants it of course). You may need to change your schedule to accommodate sessions so it’s helpful to know for how long that will be. A therapist may not be able to tell you during the evaluation how long it will take for therapy, but should be able to make a comment like “children I have seen with this specific issue before usually see me for between x-y weeks but every case is different.” Which leads to the 3rd question . . .
3. How many children have you treated that present like my child/has my child’s diagnosis? Word of caution here- just because they have not worked with a child like yours before, doesn’t mean they won’t be phenomenal. Follow up question will definitely be needed to ask about comfort with your child’s needs, if they have a supervisor or colleague that they can confer with if needed, are they willing to participate in continuing education about your child’s needs, etc. I have seen amazing therapists who were recently certified and veteran therapists who are stuck in their ways and weren’t a good fit, so it can go both ways. Which leads to the 4th question . . .
4. If your availability does not work for our schedule or we are not a good fit, are there other therapists in your practice we could consider working with? This question is awesome for two reasons: it gives you options and lets you know how open the therapist is. Most people who are good at what they do in the medical profession know that they will not be a good fit for everyone and have colleagues they are willing and able to refer to if they can’t meet a patient’s needs. Of course there are caveats for therapists who may specialize in rare diagnoses or who are new to the field, so please consider that. Which leads to the final question . . .
5. Is the therapy you are recommending covered by my insurance? Most individual therapists may not know the answer to the this question, but they, or their billing team should be able to give you the billing codes for the therapy they are recommending. You can then call your insurance and let them know the practice, the therapist and the billing codes given. You can determine frequency allowed by insurance compared to what the therapists suggested. If your child is in speech, OT, and PT or any combination be sure to ask if the number of sessions allowable per year is for EACH type of therapy or includes all of them. If not covered by insurance, or if the sessions allowed are low for your insurance, be sure to ask about price if cash pay and if the practice offers any financial assistance.
I hope these 5 questions help while you are navigating a therapy evaluation for your child. If you need additional assistance, I would love to support you and your family!
What other questions would you add to the list?