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A referral for services can be initiated by parents, family, school, or health care professionals. All inquires are treated with respect and privacy under HIPAA guidelines.
Here are some general guidelines:
If your child has had a recent occupational therapy evaluation, let us know, and we can see if you can start therapy immediately.
For children new to therapy, we will perform assessments tailored to each child’s unique needs. Assessments usually include a combination of formal testing and clinical observations.
We are an out-of-network provider, and payment for services rendered is expected at the time services are provided unless other arrangements are made.
If you have out of network benefits, it is possible that your insurance company may reimburse you in full or in part for Occupational Therapy services. Having a prescription from a physician recommending the service along with the rationale of why it is medically necessary is helpful.
While we cannot make any representation that you will be reimbursed in part or in full we can provide you with a coded paid receipt for you to submit that contains all the information typically required for processing.
Many employers offer a Flexible Spending Account “FSA” as a pre-tax benefit. You can utilize pre-tax dollars that you put into your “FSA” for medical costs, including therapy and other healthcare costs.
A Health Savings Account “HSA” is a savings account that is often used in conjunction with a high-deductible that allows users to save money tax-free for medical expenses.
The IRS considers occupational therapy to be a covered service for both FSAs and HSAs
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. Not all insurance companies have this and NONE like to advertise this, so it is something you have to 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. If there are no qualified pediatric Occupational Therapists who are in network in the Santa Barbara area, it is possible that we might be able to tap into this as a means of payment.
You will need to explain either why the existing In-Network Provider is not appropriate, or if there are no in network provider, but we are happy to help you with this if your carrier offers this. If approved, our fee may be covered in full by your insurance company.
Here is a link to one program that has been paying up to $5000 for Occupational Therapy services for each child. If you meet the criteria, we will be happy to help you fill out the necessary paperwork. United Healthcare Children’s Foundation – UHCCF. The UnitedHealthcare Children’s Foundation (UHCCF) is offering medical grants to families unable to afford child medical expenses not covered, or not fully covered, by commercial health insurance.
Families can receive up to $5,000 annually per child ($10,000 lifetime maximum per child), and do not need to have insurance through UnitedHealthcare to be eligible to receive medical grants.
Grants are available for medical costs incurred within 60 days of application and are good for one year following the month in which they are approved.
Families can use medical grants to cover the cost of deductibles, coinsurance, copays, and a variety of non-covered services and supports, including therapies, durable medical equipment, hospital stays, medication, mental health services, and most other standard/FDA approved services.