| Insurance
Milestones is an 'in
network" provider for most major insurance plans and will file claims
on your behalf. In cases we are not "in network", you will be expected
to pay for services in full and submit to your insurance company for
reimbursement.
- Aetna
- Blue
Cross Blue Shield
- CHIP
- Cigna
- Coventry
- First Health
- Great West
- Humana
- Medicaid - coming soon!
- Multiplan
- PHCS
- Texas True Choice
- Tricare
- United Healthcare
- Speech/Feeding
Therapy
- Occupational/Physical
therapy via First Health and Multiplan "Shared Savings" program. Please
refer to the back of your card and refer to the United Healthcare
website here.
Insurance Coverage -
Know the facts
- Be a smart consumer
– Know your coverage
- While an insurance
plan may provide benefits for occupational, physical or speech therapy,
there are often specific. Common exclusions and limitations may
include:
- Exclusions for
diagnoses related to developmental delay or educational in nature
- Speech coverage
only for children under three years of age
- Coverage for
therapy only when therapy is required due to injury or congenital
condition
- A limitation of the
number of therapy visits per year or per authorization.
- Some plans require a
referral and/or “pre-authorization” where the
services you wish to receive must be approved by your carrier in
advance. This may be required once for the duration your child receives
therapy, once per year, or per each block of visits granted.
- Many larger
companies and institutions with thousands of employees are
"self-funded" and set the scope of coverage for their employees. The
insurance carriers used by those companies are administrators who
merely manage claims. The reimbursements for the claims paid out come
from a pool of funds held by that company or institution. The benefits
for a particular type of service may be better or worse than the
generic plans offered by your plan's third party administrator. The
first step in establishing benefits is to speak with your company's HR
department to get the correct contact information for your plan's 3rd
party administrator.
- Avoid surprises
– Document
- Document
the date time of any discussions you have with your insurance
carrier or plan’s third party administrator, including the
name of the representative you speak with. Having this information
carries weight if there is later a dispute over coverage.
- Know that when an
insurance company representative provides a quote of benefits, it not
considered a guarantee of coverage or payment.
- Always specifically
ask for limitations or exclusions to coverage. When seeking coverage
information for multiple services, establish whether limitations and/or
exclusions apply to each service or to the group of services.
- Establish what your
deductible and out of pocket maximum is, how much of the deductible you
have met, and your coverage for the services you are seeking once your
out of pocket maximum has been met.
- Ask the
representative to repeat back to you the facts you believe you have
received.
- Catch problems early
– Read your EOBs
- An Explanation Of
Benefits is generated for each claim submitted to your insurance
company and (EOB) is your guide to the services you have received, what
you were charged and how much you owe(d).
- You and your
provider receive identical information, typically 45 or days or less
after a visit.
- It may take some
time before payment issues are identified by your provider. If you
think you see a problem, contact your health care provider’s
billing administrator immediately. You are ultimately
responsible for any services not paid by your insurance
company
- Go here for examples
of typical EOBs and how to decipher them.
- Your company's Human
Resources department is there for you – Use them
- Your HR department
manages your health plan and should be your primary resource should you
not understand your coverage.
What can I do if
therapy services are not covered?
- Check with your HR
department to see if they have any special reimbursement programs for
either the services being sought or the condition being treated.
- Call your
state’s health/human welfare agency to see if there are any
financial assistance programs.
- Occasionally,
Milestones may provide services to a limited number of patients on a
“pro bono” basis or at a reduced cost. This is
offered solely at our discretion and is typically reserved for
patients who have exhausted their benefits or who have
absolutely no means to pay for therapy services; Qualification is based
on financial ability, your child’s diagnosis and needs and
your commitment to regular attendance and participation in therapy
services.
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