Therapies and your health plan, including Vital

Disclaimer: Informational content only. Not legal, tax, financial or investment advice. Always verify with a licensed professional in Puerto Rico. Data comes from public sources — mainly each firm's website or, for doctors, the directory cited on the listing — and may change.

Speech, occupational and physical therapies may be covered by your health plan, including Plan Vital (Puerto Rico's Health Reform, administered by ASES). Coverage varies by plan and diagnosis: this guide explains how to request a referral and what to do if it is denied, without invented figures.

How to request a referral

1. Visit your primary care physician or the specialist who ordered the therapy. The referral should state the diagnosis, therapy type and recommended frequency.
2. Verify the therapist is in your plan's network. If the therapist is not contracted with your plan, ask whether they accept your plan or whether you can use an out-of-network provider.
3. The plan must authorize the service. Some services require preauthorization. Keep copies of the medical order, the referral and any authorization.
4. If your child is in the Special Education Program, therapies recommended in the PEI are coordinated with the Department of Education; the health plan and the Department are separate routes and may complement each other (see the guide to requesting services and the provisional remedy guide).

If your referral or authorization is denied

1. Ask for the explanation in writing. The insurer must tell you why it rejected the service and which policy provision it relied on. With that explanation you can identify what additional information could support reconsideration.
2. Request an internal review by the insurer itself. This is the first appeal level: ask them to reevaluate the determination with additional documentation (medical orders, evaluations, recommendations).
3. If the insurer upholds the denial, you may request an independent external review. An independent third party reviews the case and determines whether to uphold or change the decision. The Office of the Commissioner of Insurance (OCS) provides guidance on this process on its official page.
4. Keep everything: the policy, the benefits summary, the denial letter, medical orders and all correspondence.

Plan Vital

Plan Vital is the government health plan for income-eligible persons, administered by ASES. If you have Vital, your primary care physician coordinates referrals to specialists and therapies within your contracted insurer's network. For questions about your specific coverage, contact your insurer or ASES.

To find therapists with verified licenses, visit the special education & therapy category.

General information, not legal or medical advice. Reviewed 2026-11-05.