Insurance Frequently Asked Questions
What insurance plans do you accept?
We are in-network with HealthNet PPO and all Blue Cross and Blue Shield PPO plans from every state. We do not take CenCal or any other MediCal plan.
If you have a PPO plan that we’re not contracted with, you would pay for your sessions out of pocket and we can provide you with documentation to submit to your insurance for reimbursement. We can help you understand the basics of insurance billing and insurance coverage, but we will not directly engage with your insurance carrier regarding your services or reimbursement requests.
How does it work if my insurance is out of network?
That is the million dollar question! With a PPO plan, your insurance is very likely to cover speech services, but every plan is a bit different and there may be certain services that are excluded or diagnosis codes they do not cover. Some plans have speech therapy benefits but they don't cover every type of speech issue. In addition, "covered" doesn't equal "paid in full." We look up your benefits beforehand to get a sense of whether there might be any limitations or exclusions; however, it is nearly impossible to know if your insurance will pay until the claims are processed!
Will my insurance pay for speech therapy?
This varies greatly and nearly all insurance plans require you to pay something. You will likely have a deductible and a co-pay or coinsurance. We will look these up and estimate your expected fees; once your insurance processes the claims, we will have more precise information about what your portion will be for each session.
How much will my insurance pay for each session?
Usually, yes. In most cases, you will have a deductible and/or a co-pay and/or coinsurance. A deductible is a certain amount you must pay out of pocket every year before your insurance starts paying for your services. A co-pay is a fixed dollar amount you owe per visit. Co-insurance is similar to a co-pay but is a percentage that you will owe instead of a fixed amount. If you elect to use any of our non-covered services, such as consultation services, attending meetings, or extra report writing, you will pay for those directly since they cannot be billed to insurance.
Will I be charged for anything when I use my insurance?
This varies greatly from plan to plan. HealthNet requires pre-approval for a set number of visits at a time and will require a request to add more visits. Many Blue Cross and Blue Shield plans allow for at least 1 visit per week, some are unlimited, and some have strict limits such as 20 visits per year. We will look up your benefits in advance and you can also call the customer service number on the back of your card to inquire.
How many visits will my insurance cover?
With PPO plans, a referral is not required. With some more restrictive plans that require more documentation to be submitted, we will request that you contact your primary care physician to write a referral or prescription for us to submit. This helps establish “medical necessity” for your care.
Do I need a referral from my doctor?
Denials are frustrating and can be confusing to families but they do happen from time to time and are out of our control. Our office will make two attempts to get denied claims covered. If, after two attempts, the insurance still will not pay, you will be responsible for the session fees. We will be in communication with you throughout the process so you can anticipate the possible charges.
What happens if my insurance denies my claim?
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