Payments & Insurance
Our practice is currently working on becoming in-network with medical insurance providers.
However, many insurance plans offer partial coverage for families who work with out-of-network specialists. We are happy to provide a superbill and other documentation necessary for you to receive out-of-network benefits from your insurance provider. If you are not sure whether you have out-of-network benefits for specialty services, please contact your insurance provider directly.
Your child’s primary care doctor or other referring physician may also be able to answer some of these questions. If your insurance company does not have out-of-network benefits for the services provided, you are responsible for the full amount due.
All payments are required at the time of service. We accept credit card, cash, or check.
For children under the age of three, resources may be available through referrals from the Frank D. Lanterman Regional Center, which you can read more about below.
Referrals from The Frank D. Lanterman Regional Center
Uplift Therapy Center is an approved vendor with the Frank D. Lanterman Regional Center (FDLRC) to provide occupational therapy and speech therapy services for Early Intervention.
The FDLRC serves residents in the following areas: Glendale, Burbank, Pasadena, La Crescenta, La Cañada, Central Los Angeles, Hollywood-Wilshire.
Qualifying infants and toddlers under the age of three, can access our services through FDLRC. The FDLRC can often connect families to financial resources to fund these services.
To find out more, visit the application for services page linked below.
Insurance Reimbursement Option
A superbill, also known as a Statement for Insurance Reimbursement, is a document that we can give you, after you have paid your bill, in order to be reimbursed by insurance payers. This document is like a statement, but it provides additional information such as CPT codes and primary diagnosis codes.
2) Network Gap exceptions – what they are and how they work
A network gap exception (also called Single Case Agreements and Network Deficiency Coverage) is a tool health insurance companies use to compensate for gaps in their networks of contracted healthcare providers.
Things to know:
- Not all insurance companies have this, and none like to advertise this, so it is something families must ask about.
- A network gap exception does not give families carte blanche to see an out-of-network provider for whatever service you wish. When an insurer grants a network gap exception, the exception usually only covers one specific service provided by a particular out-of-network provider during a limited time frame.
- Families need to explain either why the existing In-Network Provider is not appropriate, or if there are no in network providers. The insurer may think there are in-network providers capable of providing the same service.
What Families Need for An Exception Request
- The CPT or HCPCS code describing the healthcare service
- The ICD-10 code describing the diagnosis.
- All of your contact information in addition to our contact information.
- A date range during which you expect to receive the requested service. For example, from February 1, 2018 to July 31, 2019.
- The names of any in-network providers of the same specialty within the same geographic area along with an explanation as to why that particular in-network provider isn’t capable of performing the service.
- The insurance company can pay for part of the service and the family may be responsible to pay for the balance.
Network Gap exceptions – what to do if a family’s request is denied
- Don’t give up – call the health insurance company to find out why. Sometimes, requests are denied for a simple reason such as:
- The insurer was unable to contact the out-of-network provider’s office.
- The insurer thinks there are in-network providers capable of providing the same service.
- The insurer doesn’t have the family’s correct address and think they live closer to in-network providers than they actually do.
- All of these mistakes can be cleared up. Once you understand why the request was denied, you can either appeal that decision or submit a brand-new request that includes additional information to bolster your request.
3) Single Case Agreements (SCA) – Some carriers to not have Network gap Exception policies and instead call them SCAs
A Single Case Agreement (SCA) is a contract between an insurance company and an out-of-network provider for a specific patient, so that the patient can see that provider using their in-network benefits (i.e., the patient will only have to pay their routine in-network co-pays for sessions after meeting their in-network
4) Tapping into Flexible Spending Accounts and Health Savings Account
According to IRS Pub 502, Physical, Occupational and Speech therapy services are eligible for reimbursement from flexible spending accounts (FSA), health savings accounts (HSA), health reimbursement accounts (HRA), dependent care flexible spending accounts (DCFSA) and limited care flexible spending accounts (LCFSA).
Most of the time families will know in advance that they will need therapy, so contributions can be made in advance. We can guide families on how much therapy we anticipate the child needing in the coming year. This information is good to have in November when many families are making decisions about contributions to make into a plan in the coming year.
There are some FSA plans and HSAs that allow payment to be processed like a credit card, while others require that a person submit a paid bill for reimbursement.
Get in Touch with the Uplift Therapy Center Team
Uplift Therapy Center provides pediatric occupational therapy and speech & language services. Our licensed and compassionate team members are here to support families and children of all ages. If you are not sure whether your child may benefit from our services, call us to schedule a free consultation. We are happy to answer any questions you may have.