Understanding Therapy Visit Limits and Your Insurance Benefits

Navigating insurance coverage for your child’s therapy services can feel overwhelming. Many insurance plans place limits on the number of Physical, Occupational, or Speech Therapy visits a child can receive each year. Understanding these limits early helps families plan ahead, avoid unexpected disruptions in care, and ensure their child receives the support they need.

Why Insurance Visit Limits Matter

Therapy visit limits vary widely by insurance plan. Some plans offer unlimited therapy services, while others cap the number of visits per year or per benefit period. These limits can directly impact your child’s treatment plan, so being informed allows you to partner more effectively with your child’s clinician and advocate for their needs.

Your Role as the Policy Holder

As the policy holder, it is your responsibility to understand your insurance benefits and track therapy visit usage. While our office verifies your child’s benefits prior to the start of care as a courtesy, insurance plans can be complex and subject to change. We strongly encourage families to independently review and confirm benefit details with their insurance provider.

To receive the most accurate and up-to-date information, you can:

• Visit your insurance company’s website or mobile app
• Call the customer service number on your insurance card

Key Questions to Ask Your Insurance Provider

Start by asking:
Does my child’s insurance plan have a visit limit for habilitative and/or rehabilitative therapy services, or are therapy services unlimited?

Based on the answer, consider the following:

If Therapy Services Are Unlimited

• Is this determination based on a medical diagnosis?
• If yes, which diagnoses qualify for unlimited habilitative or rehabilitative therapy?

If There Is a Visit Limit

• Does the visit limit follow a calendar year or a specific benefit period?
• How many visits are allowed for each therapy discipline (physical, occupational, speech)?
• Are visit limits combined across disciplines or separate for each one?
• Is the limit a hard limit (coverage stops entirely) or a soft limit (additional visits may be approved with review)?
• Is a medical review required after a certain number of visits?
• Can parents request additional visits or appeal for more coverage based on medical need?

Partnering in Your Child’s Care

Understanding your insurance coverage helps you work collaboratively with your child’s clinician during treatment planning. While our practice is unable to monitor visit usage for individual families, our clinicians actively involve families in care planning. Our client support team also works closely with insurance companies to submit documentation required for medical reviews or appeals.

You are your child’s strongest advocate. Our team is committed to supporting families by providing documentation for insurance appeals, assisting with grant applications, and helping explore supplemental funding options when needed.

Tips for Tracking Therapy Visits

Staying on top of visit usage can be managed in several effective ways. Families often find success using:

• A personal tracking sheet to log completed visits
• Monitoring visit usage through the insurance website or app (including both paid and pending claims)
• Health-tracking apps such as Bearable or Guava Health
• A calendar to mark therapy appointment dates

Options When Visit Limits Are Reached

If your plan includes visit limits, we encourage frequent communication with your child’s clinician as limits approach. There are often multiple options to continue care, even when insurance coverage has been exhausted. These may include:

• Discounted self-pay rates
• Group therapy sessions at a lower cost than individual therapy
• Assistance identifying grants or alternative funding sources

Our Commitment to Your Family

Your child’s developmental progress is our top priority. We hope this resource helps you better understand your insurance benefits, confidently track therapy visits, and advocate effectively for your child’s care. While insurance can be complex, you are not navigating it alone, we are here to support your family every step of the way.