Raleigh Therapy Services currently accepts:
- BlueCross BlueShield of North Carolina
- Medicaid (we accept all of the following plans)
- AmeriHealth Caritas North Carolina
- Carolina Complete Health
- Healthy Blue (Blue Cross Blue Shield)
- NC Medicaid Direct
- United Health Care Community Plan of North Carolina
- WellCare of North Carolina
- NC Health Choice
- State Employees Health Plan
- United Healthcare
- We are also contracting providers with surrounding CDSAs.
Please be sure to ask about your insurance carrier if you do not see it on our list. We are in the process of adding other insurance companies.
You may be eligible to receive out of network benefits from your insurance carrier. To see if you are eligible, call the customer service number on the back of your insurance card.
Common Insurance Terminology
Allowed Charges-Amount an insurance company will reimburse an in-network provider for services rendered to their client.
Authorization-Approval from insurance provider for a covered service to be eligible for payment. Often takes 5-7 business days and allows for a maximum number of sessions within a certain time-period.
Co-insurance-The client may be required to pay a certain % of the allowed charges as required by his/her contract with the insurance provider. For example, an insurance provider may 90% and the client may be required to pay 10% of the allowable charges.
Co-pay-The dollar amount a client is required to pay for each date of service.
Explanation of Benefits (EOB)-A description of claims processed by the insurance provider. EOBs typically include the following information: type of service, date(s) of service, billed charges, payments, reasons for denial, and patient responsibility. It is very important that you read your EOBs as we do not track benefit caps on therapy services.
INSURANCE: Professional services are rendered and charged to you, not your insurance company. Please understand that the contract is between you and your insurance company and payment for services is your responsibility. Each company negotiates different benefits and clients are responsible for understanding their individual policies. We will only file claims to insurance companies for which we are in network; however we will supply you with any paperwork needed for you to submit your claim.
Special financial arrangements must be made with the Office Manager prior to starting treatment. Our office will not enter into a dispute with your insurance company over your claim. You will receive a statement that is mailed at the 1st of each month that shows a balance due, regardless of insurance expectations. If at the end of sixty (60) days, your insurance has not paid, you will be responsible for the entire balance.
It is your responsibility to inform us of any changes in your address, phone numbers, employment and medical benefits.
In order for us to honor your insurance, we must be able to verify your coverage and current benefits. If verification cannot be made you will be responsible for the full charges to be paid at the time of service.
CO PAYMENTS AND CREDIT CARD AUTHORIZATION: Your health insurance policy may state that you must pay a co-payment for therapy evaluations and sessions. This payment is due the day services are rendered to your child/children. Raleigh Therapy Services has a contractual agreement with the health insurance carriers to collect all co-pays on the date the services are rendered.
In order to satisfy our contractual agreements with health insurance companies and accept your insurance, we require that patients leave a valid open credit card with a signature on file, authorizing Raleigh Therapy Services, Inc. to bill that card for the co-payment amount assigned by your insurance company for each therapy evaluation and session conducted. This amount is clearly listed on the Explanation of Benefits (EOB) form which is sent to you by the insurance company after each visit. Credit Card information will be stored in a professional, secure credit card system. You will receive a receipt on a monthly basis which lists charges made to your card for services rendered that month. Should you provide us with a credit card that is declined, services for your child/children will be placed on hold until you can provide us with a valid credit card. We cannot guarantee that services will be resumed immediately and your child/children may be placed on a waiting list. Raleigh Therapy Services accepts Visa, MasterCard and Discover. If your child is seen in the office, you do have the option of paying co-payments and fees at the time of service.
MEDICAID: Medicaid is the payer of last resort. If your child is covered by any other insurance, your primary insurance must be billed first. If your Primary insurance denies coverage because you are seeing an “out of network” provider, Medicaid will not pay for the therapy. If your primary insurance does not cover therapy, you must obtain a “letter of denial” before we can begin therapy or you have the option of paying privately. It is imperative that you inform us immediately if you change insurance companies at any time. Any non-payment from Medicaid will be the responsibility of the parents.
NON-PAYMENT: If payment is not made, we will either hold or terminate services. The account must be paid in full before therapy can be resumed.
BROKEN APPOINTMENT POLICY: Please consider your scheduled appointments carefully. We require a 24-hour cancellation notice. If we do not receive a 24-hour cancellation notice you may be charged a $30 broken appointment fee that will not be paid by your insurance company. If you repeatedly miss your scheduled appointments therapy may be terminated at our discretion.
Fees for Services
We offer the option of paying out-of-pocket for an evaluation and any necessary treatment sessions for those families without insurance or whose insurance company does not offer benefits for therapy services. Please contact our office for out of pocket rates.
Notice of Privacy Policies
Effective: September 23, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice will tell you how RALEIGH THERAPY SERVICES, INC. may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we call all of that protected health information, “medical information.”
This notice also will tell you about your rights and our duties with respect to medical information about you. In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.
Language Assistance Services
Raleigh Therapy Services, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
CLICK HERE for more information regarding language assistance services for individuals with limited English proficiency.