Navigating health insurance and the pre-approvals, claims, Explanation of Benefits, deductibles, co-pays and co-insurances can often feel confusing and overwhelming. Understanding what is covered, why some services are and others are not, or how to budget and plan when a new year begins and the deductible resets just adds another layer of difficulty.
At the Speech Pathology Group, our billing team wants to make the process as simple and straight-forward as possible. Let’s start with a few basics: the insurances we accept and what to expect when you begin therapy as a client.
Insurance Companies We Work With
SPGCT currently accepts private insurance from the following companies:
- Harvard Pilgrim
- United Healthcare
Medicare is approved for Speech Therapy sessions only, and Medicaid is approved for just Occupational Therapy sessions. Efforts are in the works to get OT/PT/ABA/ST all authorized for both Medicare, but that is not yet the case.
SPGCT also accepts self-pay patients. If this is of interest, please contact us directly to discuss the details. We have packages you can choose from.
One of the first steps in the evaluation process is submitting all the necessary paperwork – this includes insurance forms. Once we receive those, our office will verify eligibility and share our findings with clients. If a referral is required, the patient will need to contact the prescribing physician to have that sent to our office. The timeline for this varies by company, and we cannot schedule services until this is complete.
For insurances that required an authorization, this is requested upon completion of the evaluation. This can take up to 2 weeks depending on the insurance company. Sessions must be on hold until authorization is obtained. Once we receive that authorization, we begin scheduling. Our team will explain your benefits and what was approved, also providing estimates on out-of-pocket expenses for the therapy services. There may also be limits or caps. We will note your account if this is the case, but recommend patients also keep track in their own records.
After a therapy session is provided, the SPGCT office will bill the insurance company directly. They will reply outlining what is covered and the amount the insurance company is paying, and the balance that is the patient’s responsibility. This amount is determined based on deductibles, co-pays or co-insurance requirements for each individual plan. The patient responsibility amount is then posted to the patient account in our billing system, and an invoice is sent via email.
Payment of Invoices
The SPGCT policy when establishing a new patient account is to place a credit card on file for the billing of all invoices. One of the intake forms gives our office authorization to charge that card. It really simplifies the payment processing for both us and the patients. After receiving the payment details from the insurance company for a processed claim, and posting the patient responsibility to the individual account, the following Friday, all outstanding balances are charged to that credit card on file.
Multiple sessions may be processed together, so it’s not unusual for invoices to reflect more than one visit at a time.
When a credit card expires or is declined, we will reach out immediately to obtain new card information. Therapy services may be put on hold until that information is received.
For patients requesting a payment plan for services, SPGCT does offer this option. Please contact the billing office directly to discuss the details, as they must be approved in advance.
Any additional questions on processing insurance claims, coverage, or payment of invoices, can be directed to our billing department. We are happy to help and offer explanations. Please do not hesitate to reach out if there’s a question about an invoice.