INSURANCE REIMBURSEMENT TIPS: Speech-Language or Occupational Therapy treatment may or may not be a covered benefit under your insurance plan. Each insurance company offers a variety of plans with different benefits. Before your initial appointment and throughout the therapy process, you will need to thoroughly familiarize yourself with the benefits of your individual policy.
HOW WE ASSIST WITH INSURANCE CLAIMS: As a courtesy, we will submit claims / bill insurance companies for you and provide documentation that meets the requirements for reimbursement, should speech therapy services be covered under your plan. We document daily notes, progress notes, treatment plans and evaluation reports to support the need for services, if so requested by your insurance company.
UNDERSTAND YOUR POLICY: First, determine if your policy if an HMO, PPO or POS. HMO plans usually require individuals to receive services from a participating provider who is contracted with that insurance company. PPO and POS plans may allow individuals to receive services from "out of network" providers. Contact your insurance company to determine if speech therapy is a covered service under your plan. It is important to understand that most policies set limitations on services. Services may be capped by a dollar amount, limited to a specific number of visits or only applicable to certain diagnosis. You may also have a co-pay, deductible or co-insurance. Some insurance plans cover specific disabilities, but not others.
Please make sure to ask if any procedure or diagnosis codes are excluded from your plan.
You may be required to obtain prior authorization or pre-approval to receive therapy services. If prior authorization is required, you must obtain that in writing from your primary care physician and have them fax it directly to us as well as to the insurance company prior to the onset of therapy. Some insurance companies will only authorize a limited number of visits at one time. In this case, also request that a copy of the authorization be sent directly to you so that you can maintain a record of sessions in order to know when to ask your primary care physician for another referral for services.
Good record keeping will save you time, energy and money. Maintain a file with notes of conversations with insurance company representatives, copies of referrals, letters of medical necessity, therapist reports and billing statements.
Insurance reimbursement often takes time, so be patient but also stay on top of it to make sure that they have all information they need to process your claim.
BE AWARE OF YOUR INDIVIDUAL BENEFITS. We are here to assist you, but cannot possibly check every insurance plan. If you have questions or require additional assistance after speaking with your insurance company, please call us. If you CHANGE your insurance, you will need to let us know or you may be liable for the charges incurred.
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