When does Occupational Therapy come into play versus Coaching?
Coaching is a non-medical approach, and as such, is not a covered, clinical expense via health insurance plans. Occupational Therapy is a clinical entity, reimbursable via insurance. As a licensed Occupational Therapist, Carol treats those referred by physicians, clinical nurse specialists, social workers, or self-referrals—adolescents and adults, (and in certain cases children), when she focuses on mind-body occupation, i.e., daily living skills, vocational and avocational skills, (influenced by injury, illness, life habits, self-concept, self-image, self-esteem, psychological trauma); she evaluates inherent barriers to success by way of either physical or mental conditions which disrupt independence for any individual, (temporary, or long-term).
With thorough review of relevant test results, and previously tried treatments, Carol outlines an Occupational Therapy plan to address increasing independence, with a view to teaching alternative coping methods for effective activities of daily living (ADLs), and instrumental activities of daily living (IADLs). All chosen activities in one’s life, outside of basic self-care and hygiene, such as homemaking or home maintenance/repair, may be viewed as instrumental activities of daily living—the ways one navigates within aspects of one’s community, e.g., work, place of worship, transportation, car maintenance, shopping centers, on-line activities, recreation centers, hobbies, theaters, airline travel, school, sports arenas, visiting and engaging in activities with family and friends, outdoors, petcare, medical centers, shopping, medication management, etc.
Occupational Therapy Modalities, Training, and Referral
Training: Occupational Therapists are trained in medicine, surgery, psychiatry, psychology, as well as biomechanics, applied mechanics, kinesiology, alternative medicine/integrative medicine, adaptive aids, wheelchair measurement and orthotics, and home adaptation across the lifespan. Clients have direct access in Ohio, which means they do not need an MD referral (although insurers often have a pre-requisite of a script in order to facilitate payment).Reimbursement can be filed through insurers, who offset costs to the patient. Fortunately, when working with Carol Leslie, when a course of OT treatment has concluded successfully, a client has the option to transition away from a clinical frame of reference, and move into dynamic life coaching without changing provider, as no script is needed for a client to receive life coaching!
An excellent review of the field of Occupational Therapy can be found via the website for the American Occupational Therapy Association, www.AOTA.org. AOTA, Inc., has frequently published articles by Carol Leslie in its magazine, OT Practice, where she also ran an advice column, Entrepreneurial Resource, advising other Occupational Therapists on self-employment and entrepreneurial ideas. Her Stress Management podcast is also available as a link to the right of this page.
*Please note that payment for OT services (as with coaching) is at time of service. Carol issues a receipt comprised of ICD-10 diagnosis code(s) issued by your doctor, and the CPT OT treatment code(s), as requested by your insurance company. You simply mail in the receipts, plus your completed insurance claim form, to your insurance company for reimbursement, as covered in your policy. You will find OT is “bundled” with Physical Therapy and Speech Therapy under your medical benefit (not mental health), even if the initial reason for referral was for a mental health diagnosis, such as ADHD.Call your case manager at the 800 number for “major medical” claims, and ask what your coverage is for “out of network, outpatient Occupational Therapy.” You will probably find you have an “out of network deductible” to fulfill first. For many, this can be as low as $100–$300 per year, while for others, it may be higher, e.g., $500–700 per year.Once you fulfill that deductible, insurance often covers remaining sessions at 80% of their UCR. Ask how many sessions they will cover per year. [Carol is not affiliated with either Medicaid or Medicare. For Medicaid/Medicare clients, she is willing to use a flexible scale and/or payment plan.]