Insurance FAQ


Frequently Asked Questions About Private Out of Network Insurance

1.      How do I begin the process of finding out if I am eligible for reimbursement by my insurance provider?

We suggest you obtain a referral and authorization from your “in-network” primary health care provider to Growing Healthy Children Therapy Services.   Insurances generally look more favorably if the referring provider is in the network.

 

2.     What questions should I ask my insurance provider regarding my coverage and eligibility?

  • What are my benefits for out-of-network vs. in-network occupational therapy, speech therapy, physical therapy, and/or feeding therapy?
  • What is my out-of-network vs. in-network deductible?
  • How much of my deductible has already been met for the year?
  • How many visits are allowed per calendar year for these services?
  • What percentage of the fee per session is covered based on usual and customary charges for in-network and out-of-network?
  • Is prior authorization required?

 

3.     What if my insurance provider does not cover out-of-network services or if the percentage they reimburse is too low for me to utilize services with Growing Healthy Children Therapy Services? Do I have any other options?

We can reach out to your insurance provider to request the possibility of your insurance covering it as in-network if you meet certain criteria.

4.     What is an “in-network for out-of-network” service?

The insurance might call it an “in for out” or your provider may call it something else, but it is essentially an agreement by the insurance provider to pay the out-of-network health care provider (Growing Healthy Children) as if we were in-network provider, thus getting you a higher reimbursement.

 

5.     What criteria might make me eligible for in-network coverage?

If there are no in-network health care providers within 30 miles of your residence, that is considered a geographical reason to permit in-network coverage.  In addition, we have assisted families with getting in-network coverage because the in-network providers do not offer sufficient therapy appointments per week or do not have the specialty required to support the child’s specific needs.

6.     What steps are required to seek an “in-network for out-of-network” service?

  1. Obtain a referral to our office from your primary care provider with a diagnosis. It is helpful if the referral includes why they believe your child needs our services.
  2. The referring provider attempts to get authorization to refer to us as an out of network provider.
  3. Complete an evaluation with Growing Healthy Children Therapy Services. Be prepared to pay for that service as the insurance provider may or may not cover it retroactively.  We will bill the evaluation to increase your chances of getting reimbursed by your insurance company.
  4. We submit a letter of support from the therapist, billing coordinator, copy of the evaluation, the referral from the primary care physician, and a letter that explains our treatment approach and the research that supports this as the specialized approach your child needs.

 

7.      What is the likelihood of getting this covered?

It depends on the insurance. We have found that if you follow our recommendations above, you will increase the likelihood of being reimbursed at the in-network rate.

We are here for you and want to help!