Private Insurance

Families may also be able to continue services through private insurance if their child has a formal medical diagnosis, such as autism, developmental delay, or a speech/language disorder. Coverage varies by plan, but insurance-funded services can include occupational therapy, physical therapy, and speech therapy provided in clinics or through home-based providers. A doctor’s referral and documentation of medical necessity are usually required. 

How to get therapy through private insurance:

1. Confirm your insurance coverage

   • Call your insurance provider or check your online portal

   • Ask specifically about coverage for pediatric occupational, physical, and speech therapy

   • Write down:

     • Copay/coinsurance amounts

     • Number of covered visits per year

     • Referral or pre-authorization requirements 

     • In-network provider list

2. Obtain a medical diagnosis 

   • A formal medical diagnosis (e.g., autism, developmental delay, speech disorder, etc.) is typically required 

   • This can be diagnosed by your pediatrician or psychologist

3. Get a referral

   • Ask your pediatrician for a written referral for therapy services

   • The referral should state the diagnosis and medical necessity for OT, ST, or PT

4. Schedule an evaluation

   • Contact an in-network therapy clinic or provider

   • Schedule an initial evaluation to assess your child's needs

   • Make sure the clinic sends a treatment plan and evaluation report to your insurance company

5. Check for authorization

   • Some insurance plans require prior authorization before starting therapy

   • The therapy provider usually handles this, but confirm that approval is received before beginning sessions

6. Start therapy and track visits

   • Begin services once approved

   • Keep track of how many visits your child has used, especially if there's an annual limit 

If your doctor will not put in a referral for services but your child would benefit from them, ask for a letter of denial to give to regional center so they can cover therapy services outside of school for your child.

*Please note - individual insurance plans may have different processes, always confirm with your individual provider what requirements are and next steps

What private insurance therapy services can help with:

Occupational therapy (OT)

• Fine motor skills (e.g., grasping, using utensils) 

• Sensory processing challenges 

• Dressing, hygiene, and other self-care skills 

• Motor planning and coordination 

• Play and social participation 

• Feeding therapy (oral motor skills, picky eating, etc.) 

Physical therapy (PT)

• Gross motor development (e.g., walking, crawling, jumping) 

• Balance, strength, and coordination 

• Posture and muscle tone issues 

• Use of adaptive equipment (e.g., braces, walkers) 

• Delayed motor milestones 

Speech & Language Therapy (SLP)

• Speech sound production (articulation) 

• Understanding and using language 

• Social communication and interaction 

• Feeding and swallowing (if medically necessary) 

• Augmentative and alternative communication (AAC) 

  • If your child may benefit from a communication device, obtaining one through insurance can be an important step. Devices provided by schools are often intended for use during the school day and may not be available for home or community use. Securing a device through insurance allows your child to access it across settings: at home, in the community, and at school, supporting consistent communication and fostering greater independence. 

*Private insurance covers medically necessary services, so coverage depends on diagnosis, plan details, and documentation. Always check your policy or speak with your insurance representative to confirm what's included.

Download the private insurance checklist below: