Speech and Occupational Therapy of North Texas was formed because we love children, believe in their potential, and are committed to providing quality, caring therapies for those we serve. We want to keep the focus on helping our clients! This is our service and what we love to do. No business, however, can function efficiently without consistent revenue.
We want to get the aspect of “fueling the services” clearly established so we can then focus on what we love to do – Helping our clients meet their greatest potential! We accept cash, checks, credit cards, and insurance reimbursements to be applied to a client’s balance.
You are Responsible for Payment:
Before starting the evaluation/therapy process, we want to make sure you understand that you are responsible for payment of our services. We have clients who pay privately, clients who file their own insurance, and we also assist clients with receiving payment who are on our insurance networks. As a rule, we have good success with reimbursement from insurance or we wouldn’t continue to provide this option. But there are exceptions to every rule. You are the party receiving our service and you are responsible for payment.
Your insurance policy is an agreement between you (or your employer) and your insurance company. This coverage is a benefit of your workplace (or private policy) that supplements your financial obligations for services rendered.
If we are a provider for your insurance company, this means that we have agreed by contract to accept negotiated rates for therapy services, that may or may not meet your specific benefit plan – and that is all an insurance company has agreed to reimburse us. Using a network provider, if you have coverage, benefits you in whatever way your policy stipulates: lower co-insurance, assistance with coverage of service, as well as filing done by a provider. These benefits vary depending on your personal policy. You need to understand that nothing is certain with your coverage until you receive your first Explanation of Benefits (EOB) from your insurance company. Being a network provider does not mean that we have contractually agreed to dismiss charges not covered by insurance.
Even if we are a network provider for your insurance, you are responsible at the time of service for any co-pay, co-insurance, deductible, or other services that your insurance policy does not clearly agree to cover as a plan benefit. So in some cases, we require payment at the time of service until a determination is made by the insurance company after evaluation and/or until we receive our first EOB with payment.
If there was an assumption, based on the initial benefits quoted, that therapy is covered, but then at the time we receive an EOB we find that insurance has decided to deny coverage under your benefit plan, you are financially responsible for those charges. We will gladly assist you with an appeal if we think that will help, or with sending additional records. However, you will need to arrange for payment of the balance and for continued therapy while in this process, so that we can continue to pay our obligations related to providing therapy for your child.
Please understand – If you disagree with the insurance company’s determination, or if insurance originally made a mistake when giving us – or you – benefit information, this is an issue between you and your insurance company.
Our Contracts With Insurance Companies Do Not Require That We Check Benefits: Information We Share With You Is Not A Guarantee Of Services:
We check insurance benefits so that we will understand if you have any exclusions, deductibles, pre-existing clauses, or additional requirements on your policy (in the case that you do have coverage for therapy). This helps us determine if there are any actions we need to take before you start an evaluation and so that we can enter your child in the system more efficiently. We share the information we receive from your insurance company with you as a courtesy and not a guarantee of coverage. We are simply relaying information.
You Need to Check Your Benefits!
Since you are responsible for your treatment charges, we strongly advise you to check your benefits, as well, by calling the number located on the back of your insurance card. If your information conflicts with ours, we strongly suggest you call to get a second benefit quote and we will be happy to do the same. You will want to note the name of the representative who assisted you as well as the date of your conversation for future reference.
Please understand that true coverage determinations are often made after the evaluation and diagnosis is reviewed by your insurance, regardless of what a general representative may have originally said on the phone. Though your child may indeed need therapy, their diagnosis or treatment may not fall within your individual policy guidelines.
In the event that you do experience difficulty with reimbursement, and you feel that insurance is making a mistake, we strongly encourage you to contact your Human Resources department as well as the insurance company to express your concern. Insurance companies are much more responsive to you, as their customer. You can also make a difference in coverage in the future by lobbying with your Human resources Department.
If you cannot secure coverage, we are happy to provide therapy to you as a private client, as previously mentioned. Our priority, always, is helping your child. Private pay therapy is considered a medical expense for tax purposes and you are provided with detailed information for your records upon request. If you have any questions regarding insurance, please call our office and someone will be happy to assist you.
Thank you! We look forward to working with you and your child.