Understanding Your Insurance Benefits
Step 1
Choose your service
Select the service you’re inquiring about below. Have these codes ready when you call your insurance company.
Diagnostic Testing
- 90791
- 96112 & 96113
- 96130
- 96131
- 99215
ABA Therapy
- 97151
- 97152
- 97153
- 97154
- 97155
- 97156
For Premera plans, you might also ask about:
- H0031
- H0032
- H2014
- H2019
Speech Therapy
- 92523
- 92507
- 92508
- 92609
- 97550 & 97551
- 96112 & 96113
Feeding Therapy
- 92610
- 92526
- 97550 & 97551
Occupational Therapy
- 97165
- 97166
- 97167
- 97168
- 97530
- 96112 & 96113
- 97550 & 97551
Step 2
Call your insurance company
Call the member services number on your insurance card. Have your insurance card, your child’s date of birth, and the service codes ready before you call.
Step 3
Use this phone script
“Hi, I’m calling to understand my child’s therapy benefits. I have a few service codes from our provider. Can you help me understand what is covered?”
Step 4
Ask these questions
Getting Started
- Do I need a referral from my doctor?
- Do I need prior authorization before starting services?
Costs
- Do I have a copay or coinsurance?
- Do I have a deductible?
- How much of my deductible has been met?
Coverage
- Are these services covered under my plan?
- Are there any limits on visits?
Before you hang up
Write down the representative’s name, the date of your call, and the call reference number. This can be helpful if anything needs to be clarified later.
Why do families need to call?
Insurance companies do not always give consistent information to providers. When families call directly, the information is tied to your specific plan, which helps avoid surprises when claims are processed.
This step helps us work together so you have the clearest understanding of your benefits.