Important Insurance Information

    • PacificSource Health Plans

    • Regence Blue Cross Blue Shield

  • Feeding and speech therapy services are typically covered by insurance. Each insurance plan is different and may or may not cover all of your evaluation and treatment costs. As a one-woman show with many families to see, I DO NOT check your family’s insurance benefits prior to your evaluation and highly recommend that you verify benefits including remaining deductible costs and any copay or coinsurance responsibility, prior to your child’s initial appointment, in order to avoid any financial surprises.

    Your insurance policy is a contract between you and your insurance company. I cannot guarantee payment of your claims by your insurance company. Please let us know if you have any changes to your insurance coverage.

    If you have any questions on your coverage and/or benefits, please contact your insurance company’s member benefits line.

  • For families with an insurance plan that is not listed above, I am an out-of-network provider. As an out of network provider, I do not bill insurance. However, speech and feeding therapy services qualify for reimbursement with most insurance companies.

    If you plan to seek insurance reimbursement, each time you pay for a service, I will send you an itemized receipt (Superbill) to submit to your insurance company.

    I cannot guarantee insurance reimbursement and strongly recommend contacting your insurance company, prior to beginning therapy, to determine whether they will provide reimbursement.

  • If you do not have insurance, I do offer a 15% time of service discount for not utilizing our insurance billing services.

  • Speech and feeding therapy are typically eligible for payment with via flexible spending account.

For those using insurance to pay for services, please remember that your insurance policy is a contract between you and your insurance company. I cannot guarantee payment of claims by your insurance company. Nor can I recommend highly enough that you verify your benefits before your child’s first session. The best way to check your child’s benefits is by contacting the insurance plan’s “member benefits” line. This is usually (but not always) listed on the back of your insurance card.

I have created the following form to help you know what to ask, while on the line with your insurance company. This includes specific codes that they may require. I am happy to help you identify which codes are most likely to be used for your child’s care.

Eligibility Verification Form

Glossary of Insurance-Related Terms

  • —an insurance benefit package which details services covered, deductible, copays, co-insurance, and plan limitations.

  • —a medical provider who has a contract with the insurance plan. Note: a provider may be contracted with an insurance company, but not in-network for every plan that company offers. 

  • —a medical provider who is not contracted with the medical plan. Note: a provider may be contracted with an insurance company, but out-of-network on some plans that company offers. 

  • —the amount determined by the patient’s insurance plan that the patient must pay annually towards their medical care before insurance will contribute. Most plans will have separate in-network and out of network deductibles. Some services may not be subject to the deductible.

    As an example, if an insurance plan has a $1,500 deductible, the patient will have to pay the full allowed amount for each visit until they have reached $1,500 at which point insurance will start to pay.

    Some people have no deductible. Some people have a $7,500 deductible. Knowing what how much you will have to pay before insurance begins contributing will help you know what to expect.

  • ‍ —the dollar amount insurance companies allow for each office visit or service as determined by their contract with Alphabet Soup. For example, the clinic may charge $120 for an office visit, but the amount allowed by the insurance plan may be $80. 

    If you are paying toward your child’s deductible, you will be responsible for the allowed amount for each service, until your deductible is met.

  • —a fixed rate assigned by the insurance plan that a patient will pay for each time services are rendered.

    For example, if your insurance company has an allowed amount of $100, they might choose to pay $80 for each session and hold you financially responsible for the other $20.

  • —the percentage of the allowed amount that insurance assigns as the patient’s responsibility. Most plans will have separate in-network and out of network coinsurance rates.

    For example, if a patient has a 20% coinsurance and the allowed amount for an office visit is $120, the insurance plan will pay $96 and the patient will be responsible to pay $24 (20% of $120=$24)

  • —the maximum annual amount determined by the insurance plan that a patient will have to pay towards their medical care.

    This resets annually.

    The types of payments made by patients that go toward the out-of-pocket max are determined by your insurance company. For example, if the out-of-pocket max is $5,000, once the patient has paid $5,000 towards medical expenses, insurance will pay 100% of insurance covered medical expenses.

    Payments that contribute to the OOP max may include a combination of deductible, copay, or coinsurance paymentss.

  • —a document submitted to insurance that includes patient details, procedure codes, diagnosis codes, and cost of services in order for insurance to pay Alphabet Soup on the patient's behalf.

  • —a document provided by insurance which outlines the details of how a claim was processed. The information found on an EOB includes the allowed amount, the amount paid by the insurance plan, and the amount assigned to the patient.

  • —a process by which a provider seeks approval from an insurance plan to cover a specific treatment based on medical necessity. Some insurance companies require a preauthorization to start SLP services. Others require preauthorization to continue after a specified number of sessions.