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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.

Financial Policies

 

INSURANCE AND BILLING  

Professional services are rendered and charged to you directly, not your insurance company. Please understand that health insurance benefits are a contract between yourself and your insurance carrier. We are happy to assist you in understanding your specific benefits and responsibilities but please understand that any changes to your insurance plan can affect your coverage. It is important to notify the office IMMEDIATELY of any insurance plan changes . Raleigh Therapy Services, Inc. will file claims to insurance companies which we are in-network with. WE WILL NOT FILE ANY CLAIMS FOR INSURANCE COMPANIES WHICH WE ARE NOT IN NETWORK.

As a reminder, pre-certification does not guarantee benefits or eligibility. As clinical providers being contracted with your insurance company, we have taken the responsibility of filing your charges directly to your insurance company. Some services may be denied by your insurance company secondary to plan, medical necessity, or other policy limitations. We will attempt to re-file a denied claim on your behalf one time. If your claim is denied again, you are responsible for payment in full of all services denied or not covered by your insurance. You will receive a statement after 60 days of unpaid charges.

Monthly statements are mailed out by Raleigh Therapy Services, Inc. to the billing address on file for any amounts due on the account. Full payment of copayments, deductibles, co-insurances and non covered expenses is expected IN FULL within 30 days from receipt of your statement. 

Additional Billing Information:

  • For your convenience, Raleigh Therapy Services requires that all clients, except for those who are Medicaid recipients, have a credit card on file to cover any charges you may be responsible for. Credit cards will be charged for all applicable fees which may include but not limited to copays, late cancel fees, coinsurance or cost of visit if deductibles has not been met at the time of visit. 

  • Overdue Accounts: If your account is 30 days past due or greater, you will be subject a reoccurring late fee of 5% of the due balance every 30 days its past due. In addition, your child will be removed from the schedule and therapy will be on hold until account is paid in full. You may be required to put down a deposit for future services.  

  • Payments: Payments for services can be paid by credit card or checks if you coordinate with the business office. Checks must be made to Raleigh Therapy Services. All charges associated with the collections of the bill become the responsibility of the responsible parties. NSF checks are charged a $25.00 service fee. 

  • Cancellations: Cancellations must be made at least 24 hours prior to your child’s designated therapy time. All appointments missed without contacting your therapist via text, email or phone call at least 24 hours before your child’s scheduled appointment (Please refer to Cancellation Policy) will result in an automatic $75.00 late cancellation charge per session. 

  •  Re-Occurring Cancellations: If your child is absent from therapy 25% of the time or more for two consecutive months, or there is an extended pattern of non-attendance, therapy will be discontinued unless special arrangements are discussed in advance. 

  • Consultation Fees: We welcome the opportunity to answer your questions and discuss your concerns regarding your child. We also welcome the opportunity to collaborate with any family members or professionals who are involved in your child reaching their goals. Please note that brief discussions can take place during the first or last 10 minutes of your child’s session. Please be advised that additional collaboration time, required trainings by childcare facilities, or meetings outside of your therapist’s treatment session, will incur additional expense at the hourly rate. 

  • Referrals: It is your responsibility to make certain that any referrals required by your insurance company are obtained prior to your child’s first appointment. Without the proper referral information from your pediatrician’s office you may be responsible for a higher cost responsibility, up to 100% of the allowable charges. 

  • Medicaid: Medicaid is the payer of last resort. If your child is covered by another insurance company we are mandated by federal law to submit charges to the primary carrier first. If Raleigh Therapy Services, Inc. is not in network with your primary insurance carrier, Medicaid will not approve secondary claims for payment. Any charges not covered due to a lapse in Medicaid coverage will become the responsibility of the patient after 60 days. 

 

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: 

Your therapist is reserving your appointment time in their calendar and is only reimbursed for their time when their patients show up. If you know that you are going to miss an appointment, you must reschedule at least 36 hours before the scheduled appointment so that they have time to fill in that time slot with an alternative patient. Failure to notify your therapist of a cancellation within 24 hours before your appointment will result in an automatic non-negotiable $75 charge that cannot be reimbursed by insurance. This cancellation fee is designed to cover the therapist’s time for clients that cancel with less than 24 hours’ notice. Please be advised that this cancellation policy applies to services delivered in all settings (i.e., clinic, schools, daycare, preschools, etc.).

An appointment is considered a late cancel or a “no-show” if (1) it is cancelled less than 24 hours before the start of the scheduled appointment, (2) you arrive 10+ minutes late for the scheduled speech therapy appointment or 15+minutes late for scheduled occupational/physical therapy appointment, (3) you do not come to the office at the scheduled time, (4) you are not home when the therapist arrives for the scheduled appointment, (5) your child is not at daycare or school (including preschool) when the therapist arrives for the scheduled appointment, or (6) You do not logon for a telehealth session.

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.

To view the complete Privacy Policy, please CLICK HERE.

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.

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