Where is OT provided?
Currently providing sensory integration, feeding, and fine motor therapy in a private office clinic setting in Clifton Park, in children’s homes, and in other community settings, including daycares, preschools, and private schools.
Who may benefit from OT?
Pediatric occupational therapy is a field that takes into account functional challenges that a child or the child’s family may be experiencing in any area of the child’s daily occupations. These occupations include, sensory processing and integration, fine motor skills, self-care/ADLs, social engagement, feeding/eating, sleep, play, and more. Our practice addresses all areas of occupation in childhood, as well as working with neurodivergent adults on areas that may continue to cause challenges.
Who may benefit Sensory Integration OT?
Children who display significant needs in one or more areas of sensory processing may benefit from sensory integration therapy to promote improved functional attention, self-regulation, and a decrease in challenging behaviors. Children with diagnoses of Autism, ADHD, difficulty with attention and focus, lack of coordination, poor body awareness, sensory sensitivities, challenging behaviors with no clear cause, general disorganization, decreased self-regulation, heightened arousal, decreased awareness, and poor grading of movements may benefit from sensory integration therapy. Please refer to the sensory drop-down menu for specific areas of treatment, including, behavioral challenges, retained primitive reflexes, dyspraxia, and childhood trauma. For more information on Sensory Integration Therapy, please click here.
Will my child enjoy OT?
Absolutely! OT will give your child a fun experience through developmentally appropriate play-based activities designed to challenge the areas where they are struggling. During sensory integration therapy, this play will challenge their sensory processing and promote self-regulation. If your child becomes uncomfortable at any time during treatment, the activity will immediately be modified to ensure a positive and beneficial experience.
What is the parent’s role and responsibility?
During clinic sessions, a parent or caregiver is required to remain on-site. Parent participation is optional, but observation of sessions is strongly encouraged as it gives the opportunity to understand treatment methods and provides time for teaching of carryover activities.
What does OT cost?
Services are provided through a flexible model with a competitive private pay rate.
Discovery Call (15 minutes): Complementary
Interested in finding out if OT could benefit your child? Choose the Scheduling link from our menu to schedule a free discovery call.
Comprehensive Evaluation (1-1½ hours): $250
Evaluations include a written report with treatment plan/goals. Each evaluation will vary by child, based on needs and challenges identified by families. These may include, sensory processing/integration, feeding, self-care/ADLs, fine motor, and/or executive functioning. Regardless of how many areas of concern are identified, evaluation cost remains the same.
Please note, if a child is receiving fine motor OT through their school district, or if a school-based OT evaluation has not yet been performed, fine motor skills may not be addressed via formal assessment during this evaluation. There are a finite number of standardized fine motor assessment tools, each with a specific test/retest timespan requirement. We do not want to perform an assessment that would interfere with a child’s ability to be evaluated/reevaluated at school as test/retest timespans can be as long as 4-6 months. If you have any questions about this policy, please do not hesitate to ask. We want to make sure that children receive as much support as possible, including educationally-based OT when appropriate.
Therapy (clinic): $55/30-minutes
Clinic-based OT is most frequently provided as 30-minute sessions. However, some children benefit more from sessions lasting longer than 30 minutes. If a family is interested in 45-minute or 60-minute sessions, they will be billed accordingly, based off of the 30-minute rate.
Therapy (in-home): $55/30-minutes plus travel
Some families find it more feasible and beneficial to receive OT services in their home. Duration is flexible, as described above. Travel is billed at a rate of $15 per 10-minute increment and takes into account typical traffic patterns at the time of day when the session is delivered.
Consultation & Parent Coaching: $60/30-minutes
Parenting is a difficult task and parenting a child with sensory differences presents its own set of unique challenges. Consultation and parent coaching related to a child’s sensory processing can help families to better understand their child’s sensory processing differences, learn how to handle sensory meltdowns in a manner that is least stressful for the child and parent, educate family members and friends on a child’s needs as it relates to sensory processing, build a repertoire of proactive and reactive sensory strategies, and understand the importance of co-regulation in the parent-child relationship. Consultation and parent coaching session durations are flexible and can be in any 15-minute increment, with a 30-minute minimum.
OT via telehealth can be delivered either as direct therapy or as consultation. Direct telehealth OT is currently provided only to children within NY state. Consultation via telehealth is provided regardless of location. Telehealth session duration is flexible based on child/family needs.
Payment may be made in the form of cash, check, credit card, or FSA/HSA card, with payment due at the time the service is provided.
Do you accept insurance?
While health insurance provides OT coverage for individuals to relearn skills that have been lost due to an illness or injury (rehabilitation), it may not provide equivalent benefits to help individuals learn new skills (habilitation). In addition to differentiating between habilitation benefits and rehabilitation benefits, most insurance plans have limitations, which may include a cap on the number of covered sessions, eligible diagnosis limitation, referral requirement, and prior authorization/reauthorization. There are further limitations and exclusions for children who are receiving OT through other avenues, such as early intervention or their school setting.
Families, as well as some providers, may not be aware of the nuances of billing health insurance for developmental delays, and specifically sensory integration therapy. Unfortunately, this can lead to denials and/or takebacks, which either need to be absorbed by the provider as negative income or be passed on to families as a bill. The same is true of courtesy out-of-network billing. When our practice was in-network, these were absorbed as negative income as we felt it would be too much of a financial burden to pass on to our families. Unfortunately, no business can operate under these financial conditions long-term.
After years of being in-network with multiple health insurance companies, our practice has shifted to a cash-based model. This is a nationwide trend, especially in sensory integration, pediatric, and wellness-based OT. Not only has this allowed us to prioritize children and their families rather than complying with insurance regulations, but it has also allowed us to lower our per session rate and eliminated the possibility of surprise bills for families. Additionally, a cash-based model allows for the family and therapist to develop a treatment plan with meaningful outcomes that fits both the family’s schedule and budget. Most families choose to commit to weekly sessions rather than attending OT 2-3 times per week, with frequency decreases to prepare children and their families for discharge.
Although we do not directly bill insurance, we can easily provide families with a monthly superbill, which typically contains all of the information necessary to submit for out-of-network benefits. Out-of-network benefits vary greatly between plans, often as a percentage of the cost after subtracting the in-network copay. In general, if a plan is a PPO plan (not an EPO or HMO), it will have out-of-network benefits. In some cases, children with EPO/HMO plans may be approved for out-of-network reimbursement based on the lack in-network providers who specialize in our practice areas. Often, this must be authorized with the assistance of your child’s pediatrician prior to the start of services. The best way to find out what out-of-network benefits you may have is to contact the member services department for your insurance plan, often listed as a phone number on the back of your insurance card. We are happy to fill out any additional forms that specific insurance companies may require. To date, families have received out-of-network reimbursement from CDPHP, MVP, UnitedHealthcare, BCBS, Cigna, and Aetna.
Legal information regarding script requirements for OT in NY:
In NY, no script or referral is required for OT evaluation, treatment, or consultation unless a child requires OT due to lost skills as the direct result of an illness or injury (NYS Occupational Therapy:Practice Guidelines:Prescriptions (nysed.gov)).