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10 Facts about Insurance Billing for Therapy

Ugh. Doesn't everyone complain about insurance? We all need it though. It's too expensive, it doesn't cover enough, why do we still have to pay each visit when we're paying a monthly premium!?

Insurance can be confusing, and we're here to answer all your questions about insurance related to speech and occupational therapy!

At Simply Therapy, we accept several private insurance plans. We are currently accepting all Anthem plans, Humana, Centercare, and Tricare. The first thing we do when we get your referral is verify your insurance coverage. If we do not accept your insurance, you are welcome to pay our "private pay" rate which is due at time of service.

1) With most plans you have a DEDUCTIBLE to meet. This deductible varies, based on your specific insurance plan. Basically, you have to pay that amount (whether it be $500 or $3000) before your insurance will help you pay for services. After your claims meet that amount, you will then be required to pay a percentage of the allowed amount (getting to that in a minute).

2) ALLOWED Amount is the amount we have contracted with your insurance to pay. This is a negotiated rate. We bill out the same rate for each service, but your insurance company reduces that or "adjusts" that amount to what you or they eventually will pay.

3) Your visits are typically LIMITED. For both speech and occupational therapy, you may only have a certain number of visits per year. Be sure to confirm that with your insurance prior to starting services.

4) Insurance companies have the right to DENY services. Depending on your plan, they may not think that therapy is "medically necessary." We have billed a claim to your insurance with a code. This code states what we did during the session and the diagnosis. Some insurance companies exclude certain diagnoses: developmental delay, articulation disorder, language disorder, autism. If an insurance company denies, you are now responsible for the amount that was billed to insurance, not the adjusted amount.

5) Because there are many factors of insurance, in order to pay our labor and overhead costs, we do require PAYMENT up front. If you have a co-pay you will pay that at the time of service. We know the codes we bill and what the allowed amounts are, so we will also take your deductible/co-insurance payment at the time of service. If the claim is denied, we will reach out to you for the remainder.

6) For your convenience, we can charge your CREDIT/DEBIT CARD on the day of service. We do require to have your credit card on file. We can always e-mail receipts if you request them.

7) Our billing system sends and receives claims AUTOMATICALLY. We cannot change a denial of service, or change the allowed or deductible amount. We would be happy to print or e-mail a statement for you at any time.

8) We will work for up to 90 DAYS to retrieve payment from your insurance carrier, however, if we are unsuccessful, we will bill you the account balance.

9) We encourage you to CALL your insurance company prior to the initial visit to help you understand exactly what your insurance covers and how many visits per year you are allowed.

10) We are HERE

Insurance: A Necessary Evil

for any questions you may have during the insurance billing process. We understand that insurance can be confusing. We look forward to seeing you in our clinic!

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