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FAQ About Insurance & Billing

My insurance doesn’t require a prescription or a referral. Do I still need to provide one?

Yes.  A prescription is required for billing purposes.

Does insurance typically cover therapy?

Many health insurance plans do provide benefits for Occupational and Speech therapy, but, frequently there are limitations for this coverage.  Limitations might be related to child’s age, diagnosis, or for the number of therapy sessions a child may receive per year.  It is important for you to call your insurance company to see if your policy has any limitations. 

What is a deductible?

The deductible is the amount you are required to pay before your insurance begins payment.  The amount of the deductible varies per policy and may renew at either the calendar year or plan year depending on your individual policy.  If you have a deductible and have not met it, payment is expected at each visit until your deductible is met. 

What is co-pay?

After deductible is reached certain insurance policies have a required co-insurance due for each visit.  The co-pay amount can vary per individual policy.  Co-pays are expected to be paid upon arrival each visit.  

What is co-insurance?

After deductible is reached certain insurance policies have a required co-insurance due for each visit. This is the percentage that your individual policy requires you to pay of the allowed or contracted amount.  Co-insurance amounts are due day of service just the same as all co-pay amounts.  

What happens after I return the new patient paperwork?

Once the completed packet is returned to the office, and we have received all prescriptions needed from your physician our team of billing specialist will verify your insurance benefits.  Your packet will then be turned over to the front office staff for scheduling of an initial evaluation. However, if there are no appointment times available for regular treatment sessions, your child’s name will be added to a waiting list.  Since planning a child’s discharge from OT or SLP is difficult, it is hard to give an exact time frame for an anticipated wait.  However, most children are seen within a two to three-month period.  Recent additions to personnel should reduce the waiting period.  When an evaluation date is provided, it is important for you to verify OT/SLP service reimbursement with your insurance company.  

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