What to Do While Waiting for Insurance to Approve a Pediatric Therapy

Your child's provider has recommended a therapy — maybe physical, occupational, speech, feeding, or behavioral — and now everything is on hold while insurance decides. That waiting period can feel maddening, especially when you can see your child could be benefiting right now. The good news is that this stretch of time isn't empty. There are concrete, useful things you can do to stay organized, keep the process moving, and feel less powerless while the clock ticks.

Confirm Exactly Where the Request Stands

Before you do anything else, find out what has actually been submitted and by whom. A prior authorization is usually sent by your child's provider's office, not by you, so start there.

• Ask the provider's office for the date the request was submitted and a reference or tracking number.
• Call your insurance company's member services line (the number on the back of the card) and confirm they received it and that it's "in review."
• Ask both parties for the expected decision timeline — standard reviews and expedited reviews often have different windows.

Write down who you spoke with, the date, and what they told you. A single sheet or note on your phone with these details will save you from repeating the same calls later.

Build a Simple Paper Trail

Approvals move faster when you can quickly answer "what's missing?" Keep a small folder — physical or digital — with the therapy order, any letter of medical necessity your provider wrote, your insurance card, and your call log. Every time you contact either office, add a dated line: who you called, what you asked, and what they said.

This isn't busywork. If the request stalls or gets denied, this record is exactly what an appeal relies on. Having it ready means you're never starting from scratch.

Can My Child Start Therapy Before Insurance Approves It?

This is a decision only your child's licensed provider and the therapy practice can guide you on — not something to decide alone. Some families ask the therapy office whether a self-pay or evaluation-only visit is possible while authorization is pending, and whether any of that cost might be reimbursed later. Others are advised to wait. Ask the practice directly: "Is there anything we can safely begin now, and what would it cost us if approval comes through — or doesn't?" Get the answer in writing when you can, so there are no surprises on either the clinical or financial side.

Ask About Expediting and Keep Follow-Ups Gentle but Regular

If your provider believes a delay could affect your child, ask whether an expedited review is appropriate. Only the provider can request this on clinical grounds, so raise it with their office rather than the insurer.

In the meantime, a light, steady follow-up rhythm works better than silence or daily panic calls. A quick check-in every few business days is reasonable. When you call, be specific: "I'm checking on authorization reference #____, submitted on ____. Is anything else needed from us or the provider?" That one question catches most of the small gaps — a missing form, a signature, an extra note — that quietly hold requests up.

What Should I Do If the Wait Goes Past the Promised Timeline?

If the decision window the insurer gave you passes, call and ask why, and request the new expected date in writing. Ask whether the request is still "in review" or has moved to a different stage. If you learn it was denied, ask for the denial reason in writing and the appeal deadline immediately — appeals are often time-limited, and starting early matters. Loop your child's provider in right away, since their documentation usually anchors an appeal.

Take Care of the Waiting, Too

Approval limbo is genuinely stressful, and it's okay to name that. Keep your questions written down between calls, lean on your provider's office as your clinical anchor, and remember that a stalled authorization is almost always a paperwork problem — not a reflection of your child's needs. Steady, organized persistence is what moves these forward.

At ClearPath Pediatrics, our RN care navigators help families keep track of prior authorizations, organize the paperwork, and know who to call next — so you're not carrying the whole process alone. If the back-and-forth has become overwhelming, we're here to help you organize it.