Insurance & Billing

Tips for Getting Reimbursed

1. 1

   Call your insurance company right away

   Learn about your plan's unique benefits. Capitol Kids Therapy, LLC is not a participating provider with any plan — you will need to inquire about "out of network" benefits. Most plans cover a specific number of sessions per year or a specific dollar amount per year.

2. 2

   Understand your deductible

   Reimbursement typically begins after a deductible is met. Find out if your deductible is for the entire family or for each individual on your plan.

3. 3

   Get the right claim forms

   Ask your insurance company where to find the forms you need to submit paid invoices. Make sure your agent recognizes that you are paying out of pocket, so reimbursement checks should be made payable directly to you. Please ask us to help with your first form if you need clarification.

4. 4

   Know how sessions are counted

   Speech-language therapy is an untimed code — sessions less than 1 hour count as one session toward your total visits for the year. Most plans allow requests for additional visits, so please alert us if this applies to your plan.

5. 5

   Request authorization for additional visits

   If you have a visit-specific plan, request forms for authorizing additional visits since most therapy plans extend beyond the customary 15–30 visits allowed per year.

6. 6

   Ask about reimbursement rates and dual codes

   Ask your insurance company what your reimbursement rate will be for each unit. If your child's treatment includes oral-motor activities, ask if your reimbursement rate increases by using two codes per session: 92507 (individual speech-language therapy) and 92526 (oral-motor/feeding therapy).

7. 7

   Request a diagnostic (ICD-10) code

   Ask us for a diagnostic code so you may inquire if the diagnosis is covered under your plan. Also check what amounts are allowed for the CPT codes used on your invoice.

8. 8

   Submit invoices promptly

   Send your Capitol Kids Therapy, LLC invoices along with copies of your treatment notes to your insurance company as quickly as possible. Also check with your HR department about open enrollment periods to switch to a plan with better out-of-network speech therapy coverage.

9. 9

   Confirm direct reimbursement

   Make sure you have filled out the claim form properly to be directly reimbursed. There is a field on the claim form indicating who should receive payment — Capitol Kids Therapy, LLC should not be the recipient of reimbursement checks.