Insurance
Helpful Hints for Insurance Reimbursement
Depending upon your insurance policy,
speech-language therapy may be a covered benefit. Benefits vary greatly from
policy to policy so it is important to take the time to become acquainted with
your individual benefits. Although PSLLC is not a participating provider with
any insurance carriers, we will support you by providing appropriate
documentation of the speech-language services received at our center. We have
compiled some helpful hints to assist you in your quest for reimbursement.
Understanding Your Policy
What kind of policy do you have?
HMO, PPO, POS, etc.? Typically, HMOs require you to see a participating
provider (someone that has contracted their services to that insurance company
for a set fee). PPOs and POSs allow you to receive services from professionals
that are "out of network".
Check your policy booklet or call your insurance company to find out about your
benefits. Look for terms like "speech therapy", "speech-language
pathology", "physical therapy and other rehab services" or
"other medically necessary services or therapies" to see if it is a
covered service.
Understand if there are any limitations in your insurance policy. These may
be in the form of specific diagnosis and/or certain number of visits per year.
Is Pre-Approval Required?
Your policy booklet or your insurance representative may clarify if a
referral or pre-approval is needed for treatment or an evaluation.
If a referral is required for pre-approval, be sure to get the referral from
your primary physician before you or your child begins treatment. This referral
may be a form your doctor fills out or he/she may be required to write a letter
of referral.
Often the insurance company will pre-certify a specific number of therapy
sessions over a specific amount of time. If so, request the pre-certification
letter be mailed directly to you so that you may keep track of the number of
visits.
Keeping Good Records
Start a file and keep an accurate record of all conversations with the
insurance company representatives you speak to. Always write down their full
name and telephone extension number. Keep a copy of all written
correspondence. Have your policy ID number handy when calling them and include
it on all correspondence to the insurance company.
Submitting A Claim
If you or your child receives speech-language treatment once or twice a week,
claims may be submitted at the completion of each session or after a block of
sessions. If more sessions are needed at the end of that time, documentation of
progress may be requested by the insurance company in order to approve
additional sessions. Your insurance company is required to notify you of their
decision within 30-60 days.
If you are told that treatment for your specific diagnosis is not covered, request
the reasons in writing. This will be helpful to have in the event of an
appeal. By the same token, if you are told your treatment will be covered,
request that information in writing as well. Often an insurance company will
consider reimbursement for services if they are medically necessary. They often
deny claims that they deem educational or developmental in nature.
Always keep copies of everything you send to the insurance company in your
file. Also, call the insurance company a week after you have mailed your claim,
or a day after you have faxed it, to confirm that it has been received.
Often reimbursement takes time; it may be a lengthy process and require you
to make follow-up phone calls. If you have not heard from your insurance carrier
within 2 weeks, we advise you to be proactive by contacting them and making sure
they have all of the information they need to process your claim.
How Can Princeton Speech-Language and Learning
Center Help Me?
We will provide you with an itemized receipt that will list all of the codes
necessary to seek reimbursement. The codes are defined as follows:
Speech-language treatment is conducted in one of three ways: individual
speech-language therapy, group therapy, or intensive treatment programs.
Therapeutic programs such as Fast ForWord, Social Skills Group, Camp Fun and
Gains, or InSync are paid in full the day the program begins. At the completion
of the program, you may request an itemized receipt of which provides the dates
of the therapy sessions.
Please advise the front desk if there is additional documentation requested
by your insurance company. Typically they request information that explains the
client's treatment plan and progress.
It is important that we have a specific contact person at your insurance
company with whom to correspond. Please give us their full name, department,
direct phone number, and fax number. Additionally provide your insurance policy
number, group ID, and the policy holder's name. Please allow 2 weeks for us to
send out the necessary information to your insurance provider.
For professional help in insurance reimbursement issues, please contact
Claims Security of America at
http://www.claims-security.com/.
