Frequently Asked Questions

Our initial evaluation process is straightforward.  OT, PT and Speech Therapy requires a prescription from a medical doctor (generally your child's PCP or Psychiatrist).   Once we receive the prescription (generally faxed by the doctor to us), one of our scheduling specialists will call to get some some basic questions to determine if our programs are a good fit for the individual. If they are, we will set up an intake appointment and provide information about what to expect during the evaluation process.  

Prescriptions can be faxed to 724.342.3949 or emailed to admin@capablekidsrehab.com  

Deductible: The amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying. In general, if you have a $1,000 deductible, you must pay $1,000 for your care out of pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.

Copay: A fixed amount you pay for a covered healthcare. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication, and a $250 copay for an emergency room visit.

Coinsurance: A percentage of a medical charge you pay, with the rest paid by your health insurance plan, which typically applies after your deductible has been met. For example, if you have 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.

Visit limit: The maximum number of times you can visit a healthcare provider or receive a particular treatment within a given period. This limit varies depending on the type of plan and the insurance company.

Maximum out-of-pocket: The limit of what you’ll pay in one year, out of pocket, for your covered health care before your insurance covers 100% of the bill. The maximum out-of-pocket limit for marketplace health plans (those on the Affordable Care Act health insurance marketplace) is $9,100 for an individual and $18,200 for a family in 2023. This amount doesn’t include what you spend for services your insurance doesn’t cover.

Medically necessary: A term used to describe healthcare services or supplies that are needed to diagnose or treat an illness or injury and that meet accepted standards of medicine.

 We currently accept the fallowing insurance plan.  Please call if you have an insurance other than those listed.

Aetna 

Aetna Better Health (PA MEDICAID)

Amerihealth (PA MEDICAID)

BCBS

Cigna 

Health Partner Plans (PA MEDICAID)

Highmark BCBS

Highmark Wholecare (PA MEDICAID)

Meritain Health

Tricare 

United Healthcare

UPMC Health Plan (Excluding Partner Network)

UPMC for You (Medicaid) 

UPMC for Kids

 Although both, pediatric occupational therapy and physical therapy therapies may have similar goals, there are distinct differences in the two services.

Pediatric occupational therapy (OT) focuses on helping a child develop their skills in daily living activities such as dressing, grooming, and eating. OT also helps with fine motor coordination and sensory processing. Occupational therapists work to address emotional connections and regulation for social interaction among peers and adults. Overall, these are all examples of ways pediatric occupational therapy can help your child perform as independently and safely as possible for their age.

Pediatric physical therapy (PT) focuses on improving a child’s gross motor skills and balance. Physical therapists might help improve your child’s flexibility and strength, or recommend things like orthotics, walkers, or wheelchairs depending on your child’s specific needs. Physical therapy can also address pain management, including amplified pain, and how it impacts daily function. Pediatric PT can also help with skeletal alignment. For example, in patients with scoliosis, preventing the worsening of the condition through strength and mobility training.

In summary, the main difference between pediatric occupational therapy and physical therapy is that occupational therapy focuses on developing a child’s skills in daily living activities such as dressing, grooming, and eating while physical therapy focuses on improving a child’s gross motor skills and balance.

 Habilitative and rehabilitative services are two types of therapeutic patient care that help patients develop or regain skills and functions for daily living. Habilitative services help a person keep, learn, or improve skills and function for daily living that have not developed naturally on their own.

Rehabilitative services, on the other hand, help a person keep, restore, or improve skills and functioning for daily living that have been lost or impaired because of being sick, hurt, or disabled. 

In summary, the main difference between habilitative and rehabilitative services is that habilitative services help patients develop abilities that they otherwise have not or cannot, while rehabilitative services help patients regain functioning and skills that they’ve lost because of injury or illness.