Occupational Therapist for Child
My 5 year old son is going through a lot emotionally and academically. We met with the school of imagination and I’ve been told I need to find an occupational therapist (OT) for an evaluation however I can’t find any in the sf east Bay Area that take our insurance, BLUESHIELD PPO. We would like to stay in network since we’re paying out of pocket for so many other evaluations, tests and therapy. If anyone knows of an OT for children in Bay Area that take blueshield that would be great. I would travel up to 45 min if need be. Any other suggestions or recs would be great too. Open to anything that could help. Thanks
Mar 28, 2018
Parent Replies
Try Baby Builders in Oakland on Piedmont. Gabriela is great and we have had very good experiences with the OT and PT people who worked with our son. Very nice facilities.
http://babybuildersnorcal.com/
good luck!
Ugh. Go back to Blue Shield and file a grievance. It took me many months to force them to find a therapist who could work with my daughter. It was SO frustrating and I am convinced they make it so on purpose so we'll give up. I am so sorry you're dealing with this!
If the evaluation is for sensory processing issues, you may need to go through a developmental pediatrician or child psych first because SPD is often (not always) secondary to either Autism or ADHD. It is not a recognized diagnosis on its own and I’m not sure any insurance in California covers it, but they will cover OT related to autism or if there are self care skills (doesn’t write or use utensils or dress themselves) that are strictly OT issues. I’d start by addressing symptoms and confer with your pediatrician. Good luck - we started down the SPD path and ended up with an ASD dx, and believe it or not we are better for it - parenting a special needs child is just a different ballgame and you need different rules.
Unfortunately, a lot of OT won’t bill insurance for evaluations (or even a lot of therapy sessions depending on the type). If you are having trouble finding one in network, you can call Blue Shield and ask them for a list. If they can’t get you one within 30 miles (or maybe it’s 30 minutes), you can request and out of network referral. It basically means they authorize you to see an out of network provider covered at in network rates. You typically still have to pay out of pocket, then file a claim for reimbursement. Whether you get reimbursed depends on the diagnosis, your paper trail indicating it’s medically necessary (unusually involving a pediatrician visit/referral), documented contact with Blue Shield regarding need/provider search/case number for out of network referral, and your tenacity to stay on top of them to process the claim appropriately and actually get a check. I recommend starting a binder for all your documents, records, etc.
My daughter went to Therapy at Play in San Ramon for OT for tactile sensitivity and emotional regulation issues. I have Blue Cross/Blue Shield Federal and I think the provider list may be the same. She had a great experience with Valeen and graduated from the program.
I am sorry you are going through this! We love Angela Osterberger, who is an independent OT who will come to you at your home or at your child’s school. She is not in network, but she gives us invoices that I send to Blue Shield and they reimburse us at 70% of her actual rate so it is relatively affordable. If this sounds ok please contact me and I can connect you. I am not sure if she is taking new clients right now but worth a try.
Two very good places I know in San Ramon are The Learning Fountain, http://mylearningfountain.com/, and Therapy at Play, http://www.therapyatplay.com/. The Learning Fountain takes most insurance. I'm not sure about Therapy at Play. Good Luck,