Learn about some of the providers and plans we can accept.
Strive is actively expanding our network of Medicaid Managed Care plans, Commercial and Military (Tricare) Insurance. Please contact our office to discuss your options.
We accept most insurance plans, including Texas Medicaid Managed Care Organizations (MCOs), Marketplace plans, and employer-sponsored Commercial plans.
Private Duty Nursing, Physical, Occupational, and Speech therapy are benefits of most military-sponsored health plans through TriWest and Tricare. Specific benefits will be determined by the sponsor’s enrollment status and eligibility. Veterans may also receive services through the VA Community Care Network, subject to specific eligibility requirements, the availability of VA care, and the needs and circumstances of individual Veterans.
Our intake team will verify your benefits and explain your specific coverage before services begin.
Eligibility depends on medical needs and physician recommendations. Typically, PDN is approved for children and adults who require ventilator management, tracheostomy care, G-tube feeding, seizure monitoring, or other continuous skilled care.
Most plans cover physical, occupational, and speech therapy when prescribed by a physician and deemed medically necessary based on the documented medical or developmental need. Our clinical team will help coordinate the assessment and authorization with your health plan.
While therapy and PDN are clearly defined as benefits for qualifying Medicaid STAR and STAR Kids beneficiaries, determining commercial benefit coverage is a little more complex. Commercial payers (e.g., Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna) often cover therapy services within plan benefit limitations.
Continuous skilled nursing or Private Duty Nursing coverage varies by payer and plan. In some cases, a commercial payer may entirely exclude these benefits from its plan, which is often easy to determine. If your plan includes benefits for home health care, skilled nursing, or private duty nursing, the number of hours per week and the approved duration of care will be determined by the plan’s specific benefit details.
Our team is experienced in interpreting benefit details, understands the terminology, and knows how to navigate critical conversations during this process to identify benefits and, if available, obtain authorization for medically necessary services.
Yes. Many families have commercial insurance as their primary payer and Medicaid as their secondary payer.
Commercial insurance is billed first, and Medicaid covers the remaining eligible costs.
Our team can help you appeal insurance denials. We are experienced in the internal appeal process and in appealing to independent review organizations. We have successfully overturned authorization denials from various commercial payers and take great pride in advocating on your behalf in this process. We also help families explore waiver programs, Medicaid, or private-pay options when needed.
Yes. Texas Medicaid typically covers PDN and pediatric therapy services (OT, PT, ST) when they are medically necessary and approved by the child’s physician and the insurance authorization department. Coverage may vary by plan.
Yes. Most insurance plans require authorization before starting Private Duty Nursing or therapy services.
Strive handles the entire authorization process, including collecting documentation and submitting it to the insurance company.
Insurance companies usually require:
Any relevant medical history supporting the need for services.
Strive works directly with physicians to gather required documents.
Authorization timelines vary by insurance. Some plans approve within a few days; others may take several weeks.
Our team keeps families updated throughout the process and communicates as soon as approval is received.
Most families receiving Medicaid services have no out-of-pocket expense.
Commercial insurance may require deductibles, copays, or coinsurance.
We review all potential costs with families before services begin.
If your insurance changes, notify us immediately.
We will:
Yes. Many medically fragile children qualify for both services.
Insurance authorizations for each service type are handled independently.
Most Medicaid and commercial plans cover the initial therapy evaluation and re-evaluations when medically necessary.
We will confirm coverage before scheduling.
Yes. Insurance plans require a physician referral or order for PDN and for Occupational, Physical, and Speech Therapy.
Strive communicates directly with your child’s physician to obtain the required orders.
If nursing hours or therapy frequency need to be adjusted, Strive will:
Submit a request to insurance for additional hours or visits
Absolutely. Our intake and authorization team can walk families through coverage, authorizations, and what to expect during the approval process.
Yes. Families may pay privately for services not covered by insurance. We provide transparent pricing and flexible payment options.
Contact your local office or submit a referral form online. We’ll verify your benefits, obtain necessary authorizations, and create a personalized care plan for your loved one’s nursing and therapy needs.
Our team will guide you step-by-step through the process.
