Gap exception for OT?
If anyone has gotten (or tried to get) a gap exception from insurance for a child’s OT, I would love to know how that process worked for you. My child is autistic and was prescribed OT for issues involving coordination, self-regulation, and sensory processing. There are OTs in network, but the closest one that provides relevant services (rather than something else like hand therapy) is 30-60 minutes away, and we can’t manage that weekly. We have Anthem. Thanks in advance!
Mar 12, 2025
Parent Replies
I once lived in a rural town where the closest in-network primary care physician was 42 miles away. I worked towards getting a gap exception with my (very nice, employer-sponsored PPO) health insurance so I could see the primary care physicans in my town instead, but after countless hours of back and forth with various departments on the phone, it was clear the system was not made to handle this type of situation and it was so rarely pursed that no one knew how to help me. Given you don't have alternatives, I would still try to get the gap exception, but go in knowing it can be a long process, carefully document each step and take down the first and last name and number or phone extension of each person you talk to (sometimes the phone tree will randomly hang up on you and you have to start over). Perhaps consider seeking a professional that works over video call.