INSURANCE INFORMATION

Speech-language or occupational therapy treatment" as it is referred to by insurance companies may or may not be a covered benefit under your insurance plan. Each insurance company offers a variety of plans with different benefits. It will behoove you to thoroughly familiarize yourself with the benefits of your individual policy. CLASS, Inc. is a preferred provider for Regence and Premera. As a courtesy, we will bill other insurance companies for you and we can provide you with documentation that meets the requirements for reimbursement directly to you from your insurance company, should speech therapy services be covered under your plan.

First, determine if your policy if an HMO, PPO or POS. HMO plans usually require individuals to receive services from a participating provider who is contracted with that insurance company. PPO and POS plans allow individuals to receive services from "out of network" providers.

Contact your insurance company to determine if speech therapy is a covered service under your plan. It is important to understand that most policies set limitations on services. Services may be capped by a dollar amount, limited to a specific number of visits or only applicable to certain diagnosis.

You may be required to obtain prior authorization or pre-approval in order to receive therapy services. If prior authorization is required, you must obtain that in writing from your primary care physician and have them fax it directly to us as well as to the insurance company prior to the onset of therapy. Some insurance companies will only authorize a limited number of visits at one time. In this case, also request that a copy of the authorization be sent directly to you so that you can maintain a record of sessions in order to know when to ask your primary care physician for another referral for services.

Good record keeping will save you time, energy and money. Maintain a file with notes of conversations with insurance company representatives, copies of referrals, letters of medical necessity, therapist reports and billing statements.

Statements are issued by CLASS, Inc. on a monthly basis. Each statement includes procedure codes, diagnostic codes and fees paid by you. Your insurance company may have a form for you to attach to these statements, so check with them prior to submission. Keep copies of everything that you send to the insurance company. You may want to make a follow-up call a week or so after submission to confirm receipt of your documents. Insurance reimbursement often takes time, so be patient but also stay on top of it to make sure that they have all information they need to process your claim.

CLASS, INC. maintains stringent records and will provide you with an insurance ready statement that includes ICD-9 (diagnosis) and CPT (procedure) codes. We will work with you to provide insurance companies with treatment plans, progress notes and reports to support the need for services. Additional, professional assistance with insurance reimbursement matters can be obtained at Claims Security of America (www.claims-security.com)