The early intervention provider must verify that IFSP services are a covered benefit under insurance plan. There may be multiple plans. For example, vision related services might be covered in a separate policy.
a) Review Insurance Plan or Policy Booklet.
Ask the family to provide a copy of the policy or plan. Review the plan, noting references to IFSP services, requirements for services and exclusions. See list (c) below. A service may be listed in the Benefits Summary, but it is necessary to go to
the specific section for that benefit to determine coverage. The benefit may be under its own heading, 'Speech Therapy' or may be included in a section, such as 'Outpatient Rehabilitation Services'. For further information, also review the Exclusions
Section. There may be references in these sections to 'restorative' therapy, i.e., that which restores a previous function. There may be other subjective restrictions such as the requirement that significant improvement may be expected within two months
of initiating therapy.
b) Contact Insurance Company.
If more information is needed, it may be necessary to contact the insurance provider. Call the number on family's insurance card. If there is no number available, reference the Insurance Provider Phone Directory on the Early Intervention web site to
obtain a general number for the insurance company. When the insurance company is reached, ask to be connected with Benefits Verification. Identify yourself, say you are representing a customer and would like to verify coverage of the particular Early
Intervention service(s). If permitted, be prepared to provide policy holder's identifying information. If the insurance company will not release information, assist policy holder in obtaining the information below by making the call during a home or
office visit or by placing a conference call with the family and the insurance provider.
c) Submit documentation to the CBO.
Collect the following documentation from the family, if applicable, and submit the appropriate Statutory Waiver to the covered service providers for submission to the CBO:
- Applicable pages from plan; and/or
- Written response/denial from insurance company.