Occupational Therapy Denial

Occupational therapy focuses on the things people need to do in their daily lives, using everyday life activities to promote health, well-being, and the ability to participate in life activities. These meaningful activities include taking care of yourself and your family, volunteering, going to school, working, and accomplishing necessary day-to-day activities. Occupational therapy rehabilitation is generally 77 to 95 percent successful. 

Despite the high rate of success, insurance companies may sometimes issue an occupational therapy denial. If you find yourself in this situation, it is important that you speak to a knowledgeable occupational therapy denial attorney from the Law Offices of Scott Glovsky. Scott has been taking on big insurance companies for a very long time and is dedicated to helping people like you who are facing an insurance denial.

Page Contents:

• What Type of Ailments Can Benefit from Occupational Therapy? 
• What Types of Symptoms Can Occupational Therapy Treat?
• Why Might You Receive Occupational Therapy Denial?
• What Should You Do if You Receive Occupational Therapy Denial? 
• Which Specific Insurers Are Known to Deny Occupational Therapy? 
• How the Law Offices of Scott Glovsky Can Help with Occupational Therapy Denials 

Occupational therapy can help with the following ailments: 

• Occupational therapy can protect joints from further damage for those with arthritis, helping them accomplish ordinary tasks like bathing, preparing meals, dressing, and undressing.  
• Therapeutic interventions, including exercises, activities, and services, can greatly benefit hand pain and injuries. The goal is to restore function and allow full participation in an occupation.  
• Parkinson’s disease, an incurable, progressive nerve disorder can be helped with occupational therapy by helping the patient adapt to everyday tasks like dressing, writing, or using a computer.  
• Chronic pain affects more than 50 million adults in the United States. Chronic pain can be the result of a chronic condition, catastrophic injury, or an autoimmune disorder, and can benefit from occupational therapy.  
• Burns are often life-altering injuries that can affect recreation, sleep, work, and mobility. Occupational therapy can help burn injury patients relearn and adapt to everyday activities while managing the severe, chronic pain that often accompanies burns.   
• Cerebral palsy is often helped with occupational therapy as it can help promote independence and improve day-to-day movement skills.  
• Autism Spectrum Disorder can benefit from occupational therapy by helping individuals with ASD learn how to respond appropriately in social situations, manage sensory processing difficulties that impact everyday life, and improve physical skills.  
• Amputation rehabilitation can help patients maximize their independence and readjust to daily life with or without prosthetic limbs.  
• Traumatic brain injuries help rehabilitate patients to their pre-accident state to the extent possible. When there are irreparable gaps, patients learn new ways of performing common tasks.  
• Stroke patients benefit from occupational therapy as they are assisted in improving balance, using adaptive tools, and “rewiring” their brains through repetitive activities and tasks.

Attorney Scott Glovsky In “Global Autoimmune Institute” Feature

An occupational therapist works with patients to find practical solutions to help them maintain, regain, or improve participation in daily activities and independence. Occupational therapy is often used to treat: 

• Arthritis 
• Depression 
• Multiple Sclerosis 
• Dyspraxia 
• Chronic Pain 
• Chronic Fatigue Syndrome 
• Cerebral Palsy 
• Down’s Syndrome 
• Learning disabilities 
• Autism

Since occupational therapy can cost from $100 to $200 per hour, occupational therapy denials can be common. The goal of all insurers is to pay out as little as possible, so an insurance company may immediately deny a request for occupational therapy, claiming it is not medically necessary. Even if your doctor believes you can significantly benefit from occupational therapy, your insurer may still deny the occupational therapy request until you take further steps, including appealing the decision

If you receive an occupational therapy denial, you do have options, even though it may seem hopeless. You can file an internal appeal, asking your insurance company to reconsider its original denial and approve your occupational therapy. A letter from your doctor detailing why the occupational therapy is medically necessary may help your appeal. If your insurer still denies your occupational therapy, you can file an external appeal before a neutral third party who will decide whether your occupational therapy should be covered. Attorney Scott Glovsky can help you with the appeal process. 

Although any insurer can deny a request for occupational therapy, some are more likely than others to do so. California insurers that may issue an occupational therapy denial include: 

• Anthem Blue Cross 
• Blue Shield 
• Health Net 
• Kaiser 
• United Healthcare 
• Aetna 
• Medi-Cal Managed Care Plans

If you are facing an occupational therapy denial, it is important that you speak to a knowledgeable attorney from the Law Offices of Scott Glovsky. Attorney Scott Glovsky takes pride in the passion and integrity he brings to each client. Scott’s track record is exemplary; he has compiled a solid record of positive medical and financial results for his clients while providing the highest level of personal care and support. If you have been wronged by your insurer, we are here to help. We will listen to you, support you, and be responsive to your needs. Contact the Law Offices of Scott Glovsky today.