Please be aware that Horizon Speech Therapy Services does not accept insurance. This means that for your insurance company, we are considered an “out of network” provider. You are responsible to pay in full for the services. However, if you have a PPO-type of insurance plan, you can still use your insurance to help cover the cost of your services, because you may be eligible to be reimbursed (paid back) from your insurance company.
How does it work?
When you arrive for your appointment (for both evaluation appointments or therapy sessions), you will be paying in full, out of pocket, for the services. (We accept cash, checks, debit and credit cards, as well as FSA/HSA cards). You will then get a receipt that contains the diagnosis codes, and procedure codes. If you have a PPO-type insurance plan, you can submit that receipt, along with a medical claim form, to your insurance company. It will be applied toward your “out of network” benefits. Depending on your plan, there is typically a deductible amount that has to be met, and they will determine if you are eligible for reimbursement. The reimbursement is usually a percentage of the money you have paid (typically around 60-80%).
Understanding your insurance plan
Insurance plans can be very complicated and overwhelming. However, it is important to make sure that you understand the details of your specific plan. Every insurance company is different. Not only that, but within each insurance company, there are many different kinds of plans with different levels and amounts of coverage and benefits. Here are some important details that you should be aware of for your specific plan:
- Know the type of plan you have – As mentioned above, there are many types of insurance plans, and they all have different levels and amounts of coverage and benefits, so it is important to know what type of plan you have. Some examples: PPO, HMO, EPO, Medicaid, Medicare, etc. The type of plan is typically written (or has an icon printed) on your insurance card.
- Know your plan’s policies for speech therapy – It is important to know the insurance plan’s policies when it comes to speech therapy. They often have very specific guidelines for when speech therapy is covered or not covered. Keep in mind that feeding therapy, or oral-placement, myofunctional, and/or tongue-tie related services, still fall under the umbrella of speech therapy. Some insurance companies require that there is a medical necessity for the therapy, and may not cover developmental delays, etc. That is why it is important to be familiar with your specific plan’s policies. The way that insurance companies determine if something is covered or not, is based on the diagnosis codes and procedure codes that are included in your receipt. These codes are determined at your evaluation, based on your (or your child’s) specific areas of difficulty or disorders.
- Out of network benefits – You need to know if your plan has out of network benefits or not. What are “out of network benefits”? Some insurance plans require you to see providers that are “in network“, meaning they have a specific list of providers (doctors, therapists, etc.) for you to go to, who accept your type of insurance plan (that you must choose one of those providers). However, some insurance plans offer “out of network” benefits, which allow you to see any provider that you’d like. However, if you are going to someone who is “out of network“, you are responsible to pay for the services. You are also responsible for submiting a claim form with your itemized receipt, in order for them to process your claim and determine if you are eligible for reimbursement (that they will pay you back some of the money that you’ve spent).
- Deductibles – When an insurance plan has out of network benefits, there is usually also a deductible. What is a deductible? A deductible, is a specific amount of money that your insurance company decides will be your responsibility before they begin to reimburse you. So, for example, let’s say that your insurance plan has a $500 deductible. This means that any claims that you put in, up to $500, they will not reimburse you for them. However, after that $500 is fulfilled, they will begin to reimburse you a certain percentage of what you pay for sessions going forward.
- Specified number of therapy sessions allowed – Some insurance plans will only pay for a specified number of sessions. For example, they may only pay for 30 visits – this can be per family, per individual, per year or a specific period of time, etc. It is important to know if this applies to your plan. Additionally, some insurance companies will group together speech therapy with physical therapy and occupational therapy. So, if you (or your child) receive multiple therapies, those 30 visits may be a combined total for all the therapies. Therefore, if your plan has a specified number of therapy sessions allowed, it is important that you know what that number is, and you need to keep track of the sessions you’ve used. Your therapist cannot do that for you.
It is always a good idea to call your insurance company to ask them specific questions about your particular plan. That will help you to stay informed!
A few tips for submitting your receipts:
- Be sure to make copies of your receipts before submitting them, so that you always have a back-up in case they get misplaced by the insurance company, or if it needs to be re-submitted. Plus, its good to keep them for your own records.
- Be sure to download and print out a medical claim form, and fill out all the necessary information. Then, attach your receipt to the claim form and send it in.
- Be sure to submit your claims in a timely manner. If you wait for a long time, and then submit large stacks of receipts, it will likely cause problems….It may cause delays in the claims being processed, which in turn delays your reimbursement; Or it may lead to some claims getting misplaced by the insurance company; Or they may get “flagged” by the insurance company as something they should examine more closely, which can then lead to possible denials.