Guide for Filing for Out-Of-Network Benefits

 

 Dear Client/Parent,

 I hope this information will assist you as you contact your insurance company to determine their process for filing out-of-network benefits. It should also help you determine whether you have speech therapy benefits as part of your policy, and how to submit a claim for possible reimbursement for the services you’ve already paid for.

 

·       Call the member services phone number on the back of your insurance card.

·       Tell the customer service representative you would like information about your coverage for Speech Therapy benefits with an out-of-network provider.

·       Document your conversation:

  1.  Name of customer service representative

  2. Date of call

  3. Time of call

 

·       Have the following information ready & available for the call in the event they need it:           

               Insured’s Name:

               Patient’s name:

               DOB:

               Insurance Member ID:

               Policy/Group Number:

               Provider: Dana Wierzbicki/Infinite Horizon Speech and Language Services, PLLC

               State License: # 106876

               ASHA Certification: # 12157059

               NPI Number: 1861153041

 

·       Ask these questions when speaking to the customer service representative:

  1. What is my coverage for speech therapy benefits?

  2. Do I need pre-authorization for speech therapy? If so, how do I obtain it?

  3. Can I submit a superbill?

  4. What is the process for filing a claim after I have a superbill for services?

  5. What additional forms do I need to submit when filing my claim?

  6. Where can I find the forms on your website? Can you email me a copy?

  7. Can I file my claim online or do I need to mail/fax it to you?

  8. Do I need to file my claim within a certain amount of time after the date of service?

  9. How long does it take to process my claim?

  10. Can I appeal if a claim is denied?

 

Your insurance company MAY want to know which charge codes and diagnosis codes will be used. Until completing an evaluation, I’m unable to provide these.

During our initial phone consultation, I may let you know which of the following codes might be appropriate; however, they will be my best estimate based on the information you provide, but they may change after the formal evaluation.

 Keywords: speech therapy, stuttering, learning disabilities, dyslexia, childhood apraxia of speech, voice, teletherapy, telepractice, Texas, Houston, Cypress, Tomball, Klein, Spring, Woodlands