INSURANCE CONSIDERATIONS FOR THE INTENSIVE APHASIA PROGRAM
Adult Service
Pediatric Services
If you have commercial insurance, we will be happy to call about your eligibility and benefits for speech therapy services. The intensive aphasia program (non-intensive programs accept some insurances) acts as an out-of-network provider for the program, and you may be eligible to receive some reimbursement from your insurance company. You must pay the full amount of the program up front, then we will give you necessary information to submit the claim to your insurance carrier for possible reimbursement at the end of the session. You have the following options:
Medicare--Steps Forward is not a Medicare provider for this program. Medicare will not accept claims submitted by the patients. If you wish to use your Medicare as payment, you may not enroll in the intensive program, but must receive Medicare-funded services, typically 3 hours per week.
Medicaid--Medicaid for adults does not pay for speech or other therapy service in an outpatient setting.
Other commercial insurance--your ability to receive insurance reimbursement is dependent upon many factors. We will gladly call your insurance to determine your benefits. We will then provide you with this information and assist with obtaining an out-of-network pre-authorization if necessary.
If you also want to contact your insurance company, do the following:
1) Get the name of the person with whom you are speaking--speak with a case manager if you have one.
2) Ask what your benefits are for speech therapy services for out of network providers.
3) If you have benefits, ask what documentation the insurance company would need to reimburse for this service.
4) Within what time framework must you submit the superbill?
5) Do you have a deductible or co-pay?
Due to the small, inexpensive nature of our program, we do not have a billing or insurance specialist in our employ. To keep costs low for you, we need you to help us with these matters as much as you can.
If the carrier requires more information, refer them to our website at www.stepstherapy.net or to Dr. Bartels-Tobin at 727-823-2529.
The physician's certification form in the "downloadable forms" area will act as the physician's prescription for services.
FOR OTHER ADULT SERVICES: |
|
Steps Forward can now accept Medicare B for non-intensive services (swallowing, aphasia, dementia, ALS, PD, etc). We will also accept Aetna, Evolutions, Tricare, and BCBS for adults. The Aphasia Center is a separate company and does not accept insurance for its intensive program.
We are currently providers for the following insurance programs:
Aetna, Amerigroup, Evolutions, Medicaid, Medwaiver, Tricare and BlueCross/BlueShield of Florida. Most often commercial insurance does not cover developmental disorders, which is typically what your child's disorder will fall under. Most insurances will only cover children's issues if they were typically developing and then received a head injury or were born with a cleft palate. This pertains to Aetna and BCBS from this group.
For out of network benefits, we can call your insurance carrier and determine if your child has speech therapy benefits.
If you do have benefits, what do they pay for out of network providers? If you have a PPO you should be able to go to the provider of your choice. You will have to pay the bill and then submit a claim for your insurance company to reimburse you for this portion. We will gladly assist you with the paperwork that you will need for this.
