Question 1

Out-Of-Network Benefits and Superbills

Accepted Answer

Eat Play Love is an out-of-network provider for all insurance companies. It is a common misconception that out-of-network means that therapy will not be covered. Many PPO and POS insurances plans include out-of-network benefits and may offer 50-80% reimbursement for occupational therapy services.

HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans typically do not cover out-of-network services.

Insurances that frequently have out-of-network benefits allowing for superbill reimbursement include:
Aetna
Anthem/Blue Cross Blue Shield
Cigna
UnitedHealthcare (UHC)
Tricare
Medicare/Medicaid (coverage varies, and Medicaid providers must typically be enrolled in Medicaid to allow reimbursement)

Since we do not bill your insurance, payment in full is due regardless of any insurance claims.

Options for Submitting Superbills and Financial Planning for Therapy Services
You can submit a superbill after the first visit and wait to see what your insurance reimburses you OR you can call ahead of time and as a series of questions to find out what your plan covers.

Questions to Ask Your Insurance Company
The customer phone line should be available on the back of your insurance card.

1. Out-of-Network Benefits

“Do I have out-of-network benefits for occupational therapy?”
“Are these benefits different for in-office vs. in-home visits?”
2. Deductible + Reimbursement

“What is my out-of-network deductible, and how much of it have I met?”
“After I meet the deductible, what percentage of each visit will be reimbursed?”
“Is there a maximum allowable amount for OT services? If so, what is it?”
3. Visit Limits + Medical Necessity

“How many OT visits per year are covered out-of-network?”
“Do I need a doctor’s referral or prescription for services to be reimbursed?”
“Do you require prior authorization for out-of-network OT/feeding therapy?”
4. Billing Codes
 Ask them to check specific codes that we use for feeding therapy:

“Do you reimburse for these CPT codes out-of-network?”

97166 – OT evaluation - moderate complexity
97530 – therapeutic activities
92526 – feeding therapy/swallowing treatment

5. Filing Claims

“Where do I submit my superbill - online, fax or mail?”
“How long does reimbursement typically take?”

Once you confirm that your plan will cover partial to full reimbursement, it will allow you to access quality out-of-network feeding therapy services at more in-network cost.

Of course, I am always available for questions and happy to work with you and your family to support you in getting coverage.

Question 2

Pricing

Accepted Answer

In-Home Evaluation - $375In-Home Follow-up Treatment Sessions - $225Virtual Treatment Sessions - $165Virtual Parent Coaching Sessions - $165**Additional travel fee for areas outside of a 10-mile radius from Lake Forest **Option for in-office starting up again in October!