How to Account for Insurance Coverage Benefits By Mauricio Bertone

These days, quite a few families will have access to insurance policies offering benefits for evaluations and related services (speech, OT, PT, ABA, etc.) When families access and receive such benefits, how must they be treated and accounted for? When parents have the opportunity to access benefits under an insurance policy, the basic rule of thumb is that there is no "double dipping." By way of example, if you have already been reimbursed in full by the insurance carrier for an hour of speech therapy or some other service, it is not proper to be paid in full again by the DOE. You may, however, pursue a reimbursement claim to the extent of any deductibles or co-pays that prevented you from obtaining full reimbursement relief. For planning purposes, parents should always alert us of the existence of insurance coverage at the time of engagement or as soon thereafter as insurance benefits come into play. Whether at the hearing or in the context of settlement discussions, it is important to make disclosure that there is access to insurance coverage, and most importantly, to clearly make the further record that credit will be given to the DOE for items to the extent that they are covered under the parents' insurance policy.