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Occupational Therapy Costs – Westside Children’s Therapy
Occupational therapy is usually a 1-2 times per week service. Insurance companies will typically cover the majority of these weekly pediatric occupational therapy costs, and the patient will owe the remainder. With this consistency, we can provide an approximate estimate of what a family may owe for this service. It is important to note that every insurance plan has unique details that affect the cost of therapy for each person. Below we aim to explain how costs can vary and provide a realistic example of what a family can expect to pay for occupational therapy in a given year.
What Does Occupational Therapy Cost?
Pediatric occupational therapy is a common developmental service that is widely practiced in Illinois. Most major insurance companies will approve coverage for a majority of the expenses. In our experience, we see that insurance companies generally cover 70-80% of the annual costs for occupational therapy. The remaining percentage is owed out of pocket by the patient.
Even though insurance often covers most of the costs, patients owe expenses in the form of deductibles, copays, or coinsurances. We refer to the total amount paid for any of these costs as “Out of Pocket Costs.” We define each type below.
Types of Out of Pocket Costs
|Deductibles||The amount one must pay on their own before insurance begins covering a portion of medical costs.|
|Copays||A daily or per service fee that a minority of insurance plans charge when you come in for therapy (often $20-$50 if your plan has a copay).|
|Coinsurance||After a plan’s deductible is met, insurance plans often cover 70-100% of the ongoing costs. The amount that they do not pay is the coinsurance amount. This is owed by the patient.|
Costs Vary By Insurance Plan
Every insurance plan has different benefits details that affect cost. As a rule of thumb, if a plan has a higher deductible, copay amount, or coinsurance percentage the costs of therapy are higher. Different plans can have additional exclusions or policy differences that can affect the cost, too.
Most plans have a cap on how much one would ever have to pay out of pocket in a given year. This is referred to as a plan’s “Out of Pocket Maximum” amount. After this maximum amount is met, there is usually no additional cost for therapy. Plans with lower out of pocket maximum amounts may end up costing the family less.
Westside’s list of insurance plans that cover occupational therapy can be found on our insurance page.
A Real Example of Occupational Therapy Costs
Because every insurance plan has different benefits, the most we can do to project average pediatric occupational therapy costs is look at a typical Illinois insurance plan. To do this, we analyzed our patients’ benefits to come up with a sample plan that uses the most common plan type and deductible, copay, and coinsurance amounts. These are below:
Example Cost Analysis
Under this typical insurance plan, and assuming therapy is once per week, we can project that the family on average will pay $30-$40 per week for occupational therapy for the year. The chart below shows how the weekly costs change over time. They are high for the first 2 months and low for the next 10 months of the year. $30-$40 is the averaged amount.
At the start of the year, the plan’s deductible is not met. 100% of the weekly costs are owed by the patient until $1,200 in medical expenses is paid on the plan (i.e. the deductible). The cost during these first 2 months is usually $100 – $140 per week. The reason why there is a range is because each session has different activities performed, and each activity is charged a different amount by your insurance.
After month 2, $1,200 has been paid, and the plan’s deductible is met. Now, the insurance begins covering 85% of costs. This leaves 15% in expenses owed by the patient (i.e. coinsurance). The weekly amount becomes $18-$25 for the remaining 10 months of the year.
Accounting for the 2 months of higher costs and the 10 months of lower costs, the average cost for the year is $30-$40 per week. Payment plans can be set up to smooth out the high and low costs and keep the amount consistent every week.
Your Costs Can Differ from the Example
Most of our patients who inquire about children’s occupational therapy begin services having already paid other medical expenses elsewhere. In the example we reviewed, we assumed that the patient had $0 of their deductible met when they started. If a child already had medical expenses, the deductible would be met faster, and the average weekly cost would decrease.
Our example also assumed that patients attend 100% of their therapy sessions. In truth, attendance rates are more like 85%-95%. This lowers the costs for the year.
Lastly, if the plan had an out of pocket max amount that was met during the calendar year, the average weekly cost for the year would have decreased significantly.
On the contrary, if a plan has a higher deductible, copay, or coinsurance than in our example, the costs for a child’s occupational therapy needs may increase. The same would be true if a child receives therapy more than once per week or receives another service in addition to occupational therapy.
Find Out Your Plan’s Costs
Your costs for your child’s occupational therapy will differ somewhat from the example we went through. They will depend on your own insurance plan and your frequency of therapy. If you would like us to take a closer look at your situation, Westside can conduct a free cost analysis for you. Use the form below to learn more about your plan’s costs for occupational therapy.
Extra Information About cost of occupational therapy per hour That You May Find Interested
If the information we provide above is not enough, you may find more below here.
Pediatric Occupational Therapy Costs
Hourly wage for Occupational Therapist – Salary.com
Occupational Therapists – Bureau of Labor Statistics
Our Pricing | Little Hands Pediatric Therapy
Therapy Caps and Variation in Cost of Outpatient … – NCBI
Frequently Asked Questions About cost of occupational therapy per hour
If you have questions that need to be answered about the topic cost of occupational therapy per hour, then this section may help you solve it.
Is occupational therapy financially worthwhile?
Helping people of all ages who would ordinarily find it difficult to perform basic daily tasks is what occupational therapists (OTs) do, and patients and their families greatly value this challenging and important work.
How long does an occupational therapy session usually last?
Sessions can range in length from 30 minutes to an hour depending on the needs of the patient; for example, speech therapy sessions typically last 30 minutes, while occupational therapy sessions typically last an hour.
Where do OTs earn the highest salaries?
Home healthcare OTs typically work for private agencies in their clients’ homes, and according to the BLS, they earn the highest salaries. The annual mean wage of home health care OTs was 02,640 in 2021. The second highest-paying OT position was in nursing care facilities.
What is the occupational therapist’s lowest pay?
Occupational therapists make an average base salary of $7,273, with base salaries ranging from $8,264 to $16,855.
Why is occupational therapy so underappreciated?
“Occupational therapy is less well-known because unlike physical and speech therapy our duties are not as clearly defined,” said Kathy Jurek, occupational therapist at Warm Springs Specialty Hospital in Luling.
What are occupational therapy’s drawbacks?
You might not get a job position right away – experience is key. Occupational Therapists are expensive and difficult to find. This profession can involve a lot of travel. You also need to take many courses to get to a good level of pay.
What does occupational therapy’s “8-Minute Rule” entail?
If more than one timed CPT code is billed during a calendar day, then the total treatment time determines the number of units billed, and 1 billable unit for a timed code must be at least 8 minutes, and it does not increase to a second billable unit until you have at least 8 minutes past the 15-minute mark.
The reason a patient would require occupational therapy
For adults, this may include activities like getting dressed, cooking, and driving; for children, this may include activities like learning or playing. Occupational therapy aids individuals with an injury, illness, or disability in learning or relearning to perform daily activities.
OT or PT, who earns more money?
The average salary for an occupational therapist is $3,200 per year, while the average salary for a physical therapist is $6,850 per year. Physical therapists focus on helping patients regain range of motion and lessen pain after an illness or injury.
Can an OT make six figures?
Yes, occupational therapists can earn six figures. Management of Companies and Enterprises (9,850) and Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (4,360) are the second and third highest paying industries, respectively.
Who earns more: occupational therapists or registered nurses?
Occupational therapists make $8,700 per year, while registered nurses make $5,970 annually, per the BLS.
Is OT a difficult degree?
Even though you will undoubtedly need to put in a lot of effort and it is not an easy degree, it can be very rewarding, especially if you have a heart for working with and helping people and bringing out the best in everyone.
What’s harder, OT or PT school?
Depending on whether you want to become an OT or PT, therapy school for PTs currently requires a doctorate, whereas OT requires a master’s.