EXPLANATION OF INSURANCE PROCESS...

Insurance – What you need to know

  1. Be sure to know and understand your coverage
    1. Many insurance companies cover speech and occupational therapy. Often the coverage has it limitations. Here are some of the common limitations for speech and occupational therapy:
      1. The number of sessions is limited to a given number per year.
      2. Therapy coverage only for a congenital condition or injury.
      3. Educational related difficulties and developmental delays are not covered.
      4. Speech is covered only to three years of age.
    2. Pre-authorization is required by some insurance carriers. The pre-authorization may need to be renewed after a given number of visits or yearly.
  2. Read your insurance statements – Explanation of Benefits (EOB’s)
    1. Each claim submitted to an insurance company results in an Explanation of Benefits (EOB) that documents the services you received, the charge for each service, as well as the amount you personally owe.
    2. You and your service provider will receive identical EOB’s approximately one month after the visit .
    3. If there are payment-related issues it may take some time before thesecome to light. If you notice a problem please contact the billing administrator immediately.
  3. Document everything
    1. Know the amount of your annual deductible and how much of the deductible you have paid. Also know your out-of-pocket maximum.
    2. When talking to your insurance carrier be sure to:
      1. Get the name of the representative you talk to and ask them to repeat anything that is unclear to you.
      2. Make note ofthe time and date of the conversation.
      3. Get clarity from the representative as the limitation and exclusions of service.
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