STEPS FOR SCHEDULING AN OCCUPATIONAL, SPEECH, OR PHYSICAL THERAPY EVALUATION

• Call your child's primary care physician, pediatrician or other specialist and make sure that they are in agreement that an evaluation is warranted. Ask them to fax us a prescription for an evaluation.  Please have them specify if it is for an occupational, speech, or physical therapy evaluation. If you already have the prescription, please bring it with you to the evaluation.
• Call our office so that we can get initial information from you. This will include your insurance information. We will call your insurance health plan for a "quote of benefits". See the section under Insurance.
• The evaluation will take 1½ to 2 hours depending upon the child and the type of evaluation. Auditory Processing Evaluations are scheduled for 2 hours on two separate days.
• Plan the evaluation time when you are available to observe. It is helpful in understanding test results if you are able to observe the procedures done with your child. It is also helpful to the therapist to have your insight into the child's performance that day.
• On the day of the evaluation, please arrive at the clinic 10 -15 minutes prior to your scheduled evaluation time so that you can fill out privacy paperwork. Please bring the initial paperwork that you received in the mial with you already completed. If the paperwork is not complete, we may have to re-schedule your evaluation for another time.
• Before you leave from the evaluation, the therapist will schedule a consult to discuss the results of the evaluation, which will usually occur within two weeks after the evaluation. At the time of the consultation, the therapist will review testing results, analysis of findings, short and long term goals, and devise a therapy plan with you. You will also receive a copy of the written report.
• The therapist performing the assessment may not necessarily be the treating therapist. We try and work out the best time for the family with the therapist who has that time available in her schedule.

INSURANCE

If we are "In-Network" with your insurance company / health plan, we will file your claim and accept assignment of benefits. We are "In Network" for the following Insurance Companies:

• Blue Cross Blue Shield (BCBS) PPO Plans
• Blue Cross Blue Shield (BCBS) Healthselect
• Cigna PPO/HMO/EPO
• Private Health Care Systems (PHCS) Network PPO  / Multiplan Shared Savings Plans
• Texas True Choice Network
• Aetna PPO/HMO/EPO
• United Healthcare
• Humana (Contract in Process)

If your health plan offers occupational, speech, or physical therapy benefits, you are responsible to pay deductibles, coinsurance and co-payments that may apply at the time of service. We will call your insurance company prior to the evaluation to get a "quote of benefits". A "quote of benefits" is not a guarantee of coverage or payment; it is a quote of the level of benefits for therapy. There could be exclusions under the plan that might not be known until the claims are processed. The following are some examples of exclusions:

• Developmental delay
• Therapy only covered if due to an injury, illness or congenital issue.
• Therapy only covered if it results in significant improvement within two months.

In the event that your health plan determines a service or procedure code to be "not covered", you will be responsible for the complete charge. Payment is due upon receipt of a statement from our office.

If we are "Out of Network" with your insurance company, you are responsible for the fee at the time of service and seeking reimbursement from your insurance company. We can file your claim as a courtesy to your insurance company for additional $1 fee per Date of Service per discipline. Your insurance health plan should reimburse you directly. If you are interested in this service, please ask the office for the form, then return it to our office.

AUTHORIZATIONS

It is your responsibility to know in advance if your appointment requires a referral or authorization. If we are in-network with your insurance company and your appointment requires authorization, you will need to have the authorization / referral faxed to us prior to your appointment. If not, then your insurance company might not cover the visit and you could be responsible for a higher portion or for the full charge. You are also responsible for contacting the office before your authorization expires or the number of visits have been used, so that we may assist you in getting additional visits authorized or approved.

LIMITS

Your insurance health plan could have a limit on the amount of rehabilitation services that they will cover per calendar or fiscal year. For instance, some plans set a dollar amount that they will pay for therapy or a number of visits max per year. You are responsible for keeping track of the number of visits or dollar amount that you have used. If you exceed the limit, you will be responsible for any amount the insurance does not cover.