Health Insurance & Payment
Arming our families with knowledge to support their health needs
We recognize the financial commitment to medically necessary therapeutic services. For many of our families, it is critical that they become experts in their health insurance plans to best understand their benefits and plan for the future. We are here to support every step of the way!
Insurance Plans We Recognize
Flexible payment options available.
Stay updated with insurances we continue to contract with!
Your child's health insurance is an important resource to financially protect and support your family during medical treatment. Our goal is to ensure that families are empowered with knowledge of their health insurance benefits. The terminology can be tricky, and if not understood correctly, can lead to unforeseen hardship or changes in care.
In-Network vs. Out of Network
If a provider is 'in network' with an insurance, it means they are directly contracted with that company. They can only charge and collect the amount they agreed to in the contract. Out of network means that a provider is not directly contracted with an insurance. In this case, patients are required to pay an agreed upon rate at time of service. However, this does not mean a provider cannot submit claims on the behalf of the patient. Many patients have out of network benefits as part of their plan and can receive reimbursement for services.
Co-Payment vs. Co-Insurance
Once the deductible has been satisfied, the patient is responsible for a smaller percentage of the cost. A co-payment is a set dollar amount that a patient may owe per visit or per day of service. A co-insurance is a percentage of the cost (ex. 10-20%). This means the patient is responsible for a percentage of the contracted rate of the price.
Out of Pocket Maximum
This is the maximum amount of money your family is responsible for each year for health costs. Once the out of pocket max has been met, services are covered at 100% by insurance plan.
Some health insurance plans have a visit limit which means the amount of therapy visits a child can receive each year is capped. This is typically determined by the employer who supplies the health plan. Visit limits can be extremely challenging for families with extensive therapeutic needs. This limit is a hard cap. Once it is reached, insurance will no longer pay for services in any way. Visit limits can be exclusive to one service or be inclusive of multiple services.
The plan year is the dates in which your insurance is active and renews. This can be based on the calendar year or when the insurance was obtained. At the beginning of the new plan year, the deductible, out of pocket max, and visit limits will start over.
Frequently Asked Questions
My insurance is not in-network with your clinic. Can I still utilize it to receive services?
Yes! Many health plans have out of network benefits that can be access by their members. We require payment for services up front and can submit to your health plan for reimbursement!
I got a new job and received new health insurance. What do I need to do so my child's services are not interrupted?
Congrats! Make sure you notify the administrative team as soon as you know coverage will be changing. When you receive your new cards, send a photo of the front and back to our coordinators to ensure effective reimbursement.
My child has a diagnosis. Does that change my benefit?
In some cases, certain diagnoses can alter your health benefits plan. Many states have laws that protect families and children with disabilities from financial hardship. Call your insurance company to find out if your child's benefits change due to their diagnosis.
I have hit my visit limit! Help!
Hitting your visit limit is extremely hard for families. This is a non-negotiable determination by the employer of the health plan. Once families hit their limit, they are financially responsible for services. This would be the same no matter where the child goes for therapy. See our tips below for navigating this.
What is your payment policy?
We request payment at time of service for all families. This means if you owe a deductible amount, co-insurance, or co-payment, it is charged when the child is checked in. If an error is made in which payment was over or under paid, the family will be notified and the balance will either be collected or provided back to the family.
Will I know the cost of services before my first visit?
We complete a complimentary insurance benefit check prior to the first visit. This benefit check will be placed in an email and sent to the family. However, benefits are misquoted by insurance companies FREQUENTLY. We always recommend you know your plan and what you are entitled to!
My deductible is super high. What can we do to help cover the costs?
Many plans have a high deductible that families must first pay before insurance kicks in. We recommend utilizing an FSA (flexible spending account) or HSA (health savings account) to help support these costs. Some employers will utilize an HRA (health reimbursement arrangement) to support their employees.
I need a new insurance plan that supports my child's needs but am so overwhelmed by the choices. Help!
Our billing office would be more than happy to sit down with you and review your child's needs. From there, we can arm you with knowledge about health coverage to make the best choice.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 800-985-3059.