The world of insurance has become so complicated! We hope to help you navigate this aspect of your child’s services and gain an understanding of how payment can be made for therapy.
Every insurance plan is different. Before scheduling your child’s first visit, check with your health insurance carrier to see if you are covered and learn the specifics of your coverage. Insurance plans are agreements made between you and your insurer, and Center for Pediatric Therapy cannot ensure that an insurance carrier will pay for your child’s services. It is your responsibility to understand what types of coverage your health insurance provides and to be sure that you meet all requirements stipulated by your specific plan. Here are some questions to ask of your insurance carrier:
- Does my plan provide coverage for my child’s occupational, physical, and/or speech therapy?
- How many visits are allowed under my insurance plan?
- If my child needs several therapies, will the same number of visits be allowed for each?
- Are there any exclusions or limitations to therapy coverage? For example, some insurance plans will not cover services for children diagnosed with developmental delay.
Your health insurance carrier will be able to inform you of your level of coverage and what, if any, copayments, coinsurances and deductibles will be your responsibility.
There are 3 options for payment of your child’s therapy:
- Blue Cross/Blue Shield
- United Healthcare (but not Oxford)
We encourage you to call your insurance carrier’s Member Services line to verify your plan’s coverage for your child’s needs.
If you are enrolled in a managed care group, such as an HMO or PPO, you might need a referral from your primary care physician. Please contact your physician for authorization and a prescription for service, including any diagnosis your child may have, before your appointment.
As a courtesy to our patients, we will obtain your benefit information from your insurance carrier prior to your first visit. Although we have verified your benefit, this is never a guarantee of payment. Some or all of the services provided in your treatment may be “not covered” services under your particular plan, and these charges are your responsibility.
We will also process your claim with the insurance carrier for your therapy treatments. Depending on your insurance plan, you might be required to pay a co-payment , co-insurance, or a deductible.
- Co-payments are due at the time of the visit.
- After your insurance company processes your claim, your insurance plan may require that a co-insurance and/or a deductible payment is due from you. Center for Pediatric Therapy will send you a statement of the balance due.
- Statements are mailed on a monthly basis, only if there is a balance due on your account.
- Payment is expected within 30 days of your receipt of the statement.
Please be sure to bring your insurance card with you when you come to the office.
Out-of-network refers to insurance companies with whom Center for Pediatric Therapy is not a participating provider. This does not mean that your insurance plan will not pay for the service. Rather, it means that you – as the contract holder – need to do more of the preparation work in order to assure reimbursement. While we will make every attempt to support your insurance reimbursement, you are the contract holder. Therefore, it is your responsibility to pay for the services if denied by the insurance carrier and settle disputes with the insurance carrier directly.
As the Center for Pediatric Therapy does not have a contract with your insurance carrier, you must:
- Contact your insurance company in order to verify what your insurance plan allows for your child’s therapy services. Make sure that you ask about the specific type of therapy your child is receiving because there may be different coverage for Occupational Therapy, Speech Therapy, and Physical Therapy services.
- Call our office with any requirements by your insurance company for prior authorization or documentation. Please include all necessary contact information so that we can get documentation to the insurance company in a timely manner.
- Bring your updated insurance cards to our office to keep on file – this allows our documentation to reference your current plan information.
- Make payment to Center for Pediatric Therapy each month for services rendered.
Each month, we will provide you with 2 documents:
- Invoice: Forward this to your insurance company to process for payment. Invoices print out per provider requirements.
- Statement: The amount indicated after “Please Pay” is the current outstanding balance on your account. Payment is expected within 30 days of receipt of this statement. Statements only print if there is a balance due on your account. If you do not receive a Statement, then you currently have no balance due.
Please call Diane at the Fairfield office with any questions at 203-255-3669.