Billing, Payments, and Processes

We typically submit claims within 14 days of service, but insurance companies may take 90 days or more to process them. We cannot predict processing times or control how your insurance applies benefits, as therapy visits may be categorized differently depending on your plan. 

Common insurance categories include: 

Rehabilitation vs. Habilitation: Rehabilitation means regaining a lost skill, while habilitation means developing a new skill. Many of our services may be considered habilitative, but this varies by payer. These categories may have different authorization requirements, benefit limits, or exclusions. Our office does not determine how your insurance will categorize services before billing. 

Physical Health vs. Mental Health: Depending on the diagnosis code used for your child’s referral or therapy services, benefits may be processed under physical health or mental health. Our office cannot control this category, and costs may vary. Different therapies, such as physical therapy and speech therapy, may process differently for the same child. 

To better understand how benefits may be processed, contact your insurance company and ask them to run a “test claim.” Our office does not run test claims before treatment. 

We recommend running a test claim with your insurance company to better understand your potential costs for therapy services. 

How to Run a Test Claim 

1. Call our office to request your child’s billing codes, including: 
   • ICD-10 Code(s): Diagnosis codes used for billing. Your child may have more than one code. Our office will provide you with the codes and tell you the order in which they should be listed. 
   • CPT Code(s): Procedure codes that may be 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 your insurance company to run a test claim for your child’s therapy services using the codes provided. Be sure to ask about therapy service limits, deductibles, co-insurance, exclusions, and any other out-of-pocket costs. Different services may process differently, which can affect what you owe. 

If your child has more than one insurance plan, you must confirm which plan is primary and which is secondary. This is determined by insurance rules and is not something you choose. 

To avoid denied claims or surprise bills: 

1. Provide our office with accurate information for all insurance plans so we can bill correctly. Missing or incorrect information may make you responsible for costs. 
2. Contact your insurance companies to confirm which plan is primary and which is secondary. 
3. Respond to any insurance requests to update your information to avoid denied claims. 

If a claim is denied for “Coordination of Benefits,” you must contact your insurance company to correct it, or you may be responsible for the visit cost. 

• Deductible: This is the amount you have to pay before your insurance benefits pay their portion. If you have a $1,000 deductible, you will have to pay this amount before your co-insurance kicks in.  
• Co-Insurance: A percentage of the billed amount you pay after your deductible is met. For example, with 20% co-insurance on a $100 bill, you pay $20, and insurance pays $80. 
• Co-Pays: A set amount you pay per visit, such as $30. In many cases, co-pays apply even if your deductible has not been met. 

Our office sends a separate invoice for each month when claims are processed and charges are incurred. You will not receive an invoice until your insurance has processed your claims. Multiple invoices mean multiple balances are due. 

Balances are due upon receipt. If you cannot pay in full, please call our office to set up an official payment plan. Invoices 90 days past due may be sent to collections, even if partial payments were made, unless a payment plan is in place. Therapy services may be suspended at that time. We do not make individual phone calls about past-due balances. 

You can pay your bill in a variety of ways.  

1. Online Patient Portal: There is a 3% card processing fee, except for HSA cards. Call our office if you need a new invitation link. 
2. Call Our Billing Office at (360) 800-6401: There is a 3% processing fee for all card payments except for HSA cards. 
3. Mail a personal check. 
4. Use your bank’s online bill pay. 
5. Pay in person by card, check, or cash. There is a 3% processing fee for all card payments except for HSA cards.