Insurance Benefit Information
We do our best to verify your insurance and obtain authorization for therapy visits but we cannot guarantee that all services will be covered by every insurance. Insurance companies are increasing their requirements exponentially in an effort to reduce their costs and this limits our ability to see your children under your insurance coverage.
Please contact your insurance company directly to see if our services are a covered benefit with your insurance plan. We are able to work with families with all insurances as an out-of-network provider or as private pay.
How Will My Benefits Be Processed?
Unfortunately we cannot predict how your benefits will be processed by your insurance company. There are many categories that your insurance may use. Some of the common buckets insurance place therapy visits from our clinic are:
1. Rehabilitation vs Habilitation: Rehabilitation is regaining a lost skill. Habilitation is working to gain a new skill that was not lost. Many of our services are considered habilitative in nature by many payors, but not all payors. Rehabilitative services and habilitative services often have different requirements for prior authorizations, they have different benefit limits, and sometimes one category is excluded in your plan. Our office DOES NOT determine which category your insurance will process your payments prior to billing. This is something you can do by calling your insurance company and asking them to run a "TEST CLAIM" (details below).
2. Physical Health vs Mental Health: Depending on the diagnosis code that was used by your doctor and/or therapist when your child was referred for therapy services, your benefits may be processed under physical health benefits or mental health benefits. Our office has no control over which category will be used by your insurance company. Many plans have very different costs associated with physical health vs mental health benefits and you will be responsible for your portion of the costs. It is important to note that two different therapists (for example physical therapy vs speech therapy) may process in two different categories for the same child. The only way you can determine how these will process is for your to call your insurance company and run a "TEST CLAIM" (details below). Our office DOES NOT run test claims prior to treatment.
Test Claims:
We highly recommend you run a test claim to better understand what you will owe for therapy services based on your insurance company's benefits. Here are the steps to running a test claim:
1. Call our office and request the codes being used for your child's therapy so you can run a test claim.
** You will need to provide the ICD-10 code that our clinic is using to bill your services. This is the diagnosis code. Your child may have more than one code. Our office will provide you the codes and tell you the order they should be listed.
**You will need to provide the CPT codes that our clinic is using in therapy. These are the "procedures" being used in therapy. Our office will provide you with all the potential CPT codes that may be used in therapy.
2. Call the member number on your insurance card
3. Ask to run a TEST CLAIM for therapy services for your child. You will provide the codes you have received from our office. You want to find out:
* Limits to your therapy services
*Your associated costs (i.e. deductible, co-insurance, exclusions to services, etc). Remember, different services will be processed in different ways by your insurance and you may have very different expenses based on how the visits are processed.
We are in-network for the following insurances:
Aetna
Anthem Blue Cross
Community Health Plan of WA (no new referrals)
Cigna
Coordinated Care (no new referrals)
First Choice Health
First Health/Coventry
Health Net
Lifewise WA
MODA
Molina (limited new referrals - physical therapy only)
PacificSource
Premera Blue Cross WA
Premera Lifewise OR
ProviderOne (no new referrals)
Regence Blue Shield of OR/WA
Tri-Care
United Healthcare (no new referrals)
Due to an unwillingness from the payors to negotiate new reimbursement rates we are no longer accepting any new referrals for: Molina, United Healthcare/UMR/Optum, CHPW, Coordinated Care, Wellpoint, Provider One
We are terminating our contracts with the following insurance companies as of 10/31/2025: Community Health Plan of Washington, Amerigroup, Wellpoint, Coordinated Care
Please contact your insurance company directly to see if our services are a covered benefit with your insurance plan. We are able to work with families with all insurances as an out-of-network provider or as private pay.
How Will My Benefits Be Processed?
Unfortunately we cannot predict how your benefits will be processed by your insurance company. There are many categories that your insurance may use. Some of the common buckets insurance place therapy visits from our clinic are:
1. Rehabilitation vs Habilitation: Rehabilitation is regaining a lost skill. Habilitation is working to gain a new skill that was not lost. Many of our services are considered habilitative in nature by many payors, but not all payors. Rehabilitative services and habilitative services often have different requirements for prior authorizations, they have different benefit limits, and sometimes one category is excluded in your plan. Our office DOES NOT determine which category your insurance will process your payments prior to billing. This is something you can do by calling your insurance company and asking them to run a "TEST CLAIM" (details below).
2. Physical Health vs Mental Health: Depending on the diagnosis code that was used by your doctor and/or therapist when your child was referred for therapy services, your benefits may be processed under physical health benefits or mental health benefits. Our office has no control over which category will be used by your insurance company. Many plans have very different costs associated with physical health vs mental health benefits and you will be responsible for your portion of the costs. It is important to note that two different therapists (for example physical therapy vs speech therapy) may process in two different categories for the same child. The only way you can determine how these will process is for your to call your insurance company and run a "TEST CLAIM" (details below). Our office DOES NOT run test claims prior to treatment.
Test Claims:
We highly recommend you run a test claim to better understand what you will owe for therapy services based on your insurance company's benefits. Here are the steps to running a test claim:
1. Call our office and request the codes being used for your child's therapy so you can run a test claim.
** You will need to provide the ICD-10 code that our clinic is using to bill your services. This is the diagnosis code. Your child may have more than one code. Our office will provide you the codes and tell you the order they should be listed.
**You will need to provide the CPT codes that our clinic is using in therapy. These are the "procedures" being used in therapy. Our office will provide you with all the potential CPT codes that may be used in therapy.
2. Call the member number on your insurance card
3. Ask to run a TEST CLAIM for therapy services for your child. You will provide the codes you have received from our office. You want to find out:
* Limits to your therapy services
*Your associated costs (i.e. deductible, co-insurance, exclusions to services, etc). Remember, different services will be processed in different ways by your insurance and you may have very different expenses based on how the visits are processed.
We are in-network for the following insurances:
Aetna
Anthem Blue Cross
Community Health Plan of WA (no new referrals)
Cigna
Coordinated Care (no new referrals)
First Choice Health
First Health/Coventry
Health Net
Lifewise WA
MODA
Molina (limited new referrals - physical therapy only)
PacificSource
Premera Blue Cross WA
Premera Lifewise OR
ProviderOne (no new referrals)
Regence Blue Shield of OR/WA
Tri-Care
United Healthcare (no new referrals)
Due to an unwillingness from the payors to negotiate new reimbursement rates we are no longer accepting any new referrals for: Molina, United Healthcare/UMR/Optum, CHPW, Coordinated Care, Wellpoint, Provider One
We are terminating our contracts with the following insurance companies as of 10/31/2025: Community Health Plan of Washington, Amerigroup, Wellpoint, Coordinated Care
