If your plan requires you to only render services with providers in-network, you may be offered an ‘out of network exception’ since aquatic therapy is a specialty service and may not be offered in your area. It is important that if you do so, you work with a case manager to ensure approval.
Often, since we are not contracted by insurance, there are difficulties with reimbursement despite the initial ‘approval’. If you can prove that there are no in-network providers in your area that can do the specialized therapy for your child’s needs, you can be granted an ‘out of network exception’. They may ask you to call your provider when this is getting approved.
Make sure to have all tax ID, NPI, CPT and diagnosis code (ICD 10) information for this call.
