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Private Pay Occupational Therapy

Private pay or cash-based therapy simply means I do not bill your insurance on your behalf. If you have heard of the term cash-based therapy or private-pay therapy, you may be asking yourself, “why would I pay out of pocket for a service I can get through my insurance?” It is a valid question and my most asked question since owning a private-pay therapy business. Hopefully, I am able to fully answer your question in this post and as always if you have any further questions about payment or what I do, please email or call me.


Pros of private pay

First, I want to talk about the benefits of your child seeing a therapist that is private-pay. For my own business, I see children in their home which is the environment that is most practical (in most cases) for therapy to take place. Children are using the skills they are needing help with in a natural way, which in turn generates quicker outcomes. This is case by case, but majority of the time I find therapy to be more beneficial and effective when we are in the natural environment.


A second benefit, is we will have no restrictions on number of visits or length of visits, we will have the ability to choose the most relevant environment for the skills being addressed, and we don’t have to wait on insurance approval. We get to make a very specific and unique plan of care that is appropriate for your child’s current needs.

Another important aspect to consider when choosing therapy for your child is the connection and relationship your family and child have with your therapist. We are not a one size fits all and it is important to consider finding a therapist that fits your child’s personality and finding a therapist you trust. I keep my caseload low in order to give my full attention to the children I am working with and strive to provide the best possible care you and your child deserve. If I am not a good fit, I will help you find a therapist that best suits your needs.

When it comes to paying for therapy, there are various avenues you can choose. I am able to take credit cards through your Health Savings Account, I offer flexible payment plans, and if your insurance has Out of Network benefits I will work with you on how to submit for reimbursement. I am also a provider through the Delaware County Board of Disabilities that provides funding for families who qualify. Below are the steps that we typically take when submitting to your insurance.


Out of Network Benefits

When submitting to insurance for reimbursement I will provide you with a Superbill, which is a term that is used to describe a statement of the services your child was provided. This superbill contains all the necessary information insurance will need in order to determine if the services are covered by your out of network benefits. Each insurance will have unique policies when it comes to reimbursing services out of network.


Steps to submit a Superbill

  1. Prior to scheduling an evaluation, call the number on the back of your insurance card for your members service

  2. Ask for verification of out of network benefits for child’s occupational therapy

    1. Fill out my form for out of network benefits and ask your insurance provider the questions on the form

  3. Verify how to submit a superbill

  4. Confirm they have your correct home address.

  5. Submitting a superbill can be done by the following ways and each insurance will be different

    1. Fax

    2. Mail

    3. Upload to company’s portal

  6. After your bill is received and processed you will receive a payment

Conclusion

Submitting a superbill for reimbursement can seem like a difficult process but if taking this step means your child is receiving therapy that is best suited for them, the process doesn’t seem as daunting. I am here to assist as much as I can and hope to be a support for you as you navigate this process. Having a clear understanding of your benefits is going to create the best chance of reimbursement through a superbill.

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References

Williams, M. (2020, October 23). What is a superbill and how is it used for therapy? Choosing Therapy. Retrieved November 23, 2021, from https://www.choosingtherapy.com/superbill/.


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