When starting therapy, there are different ways to go about paying for it. Most of the time you’ll be able to submit it to your insurance company and they will be able to pick up some of the patient responsibility for you! If you are wondering how much they will pick up, you can call them to see what your therapy benefits are. Do you need to call your insurance company but have no idea where to even start? Here are some tips and tricks that might be useful.
What Information Do I Need to Contact My Insurance Company?
Do you need to call your insurance company but have no idea where to even start? Here are some tips and tricks that might be useful.
- Insurance Company’s phone number – This number can usually be found on the back of the insurance card. There might be a few different phone numbers there so make sure you call the one that states, “Member Services”.
- Insurance ID Number – This can be found on the front of your insurance card. Often it is labeled as “Member ID Number”. Provider’s Full Name – Make sure you have the Provider’s/Facilities office’s full name. For example, if you see Dr. John but his full name is Dr. John Smith, you will have to have the last name as well.
- Providers NPI Number – You can get your provider’s NPI Number by calling the office and asking for it. It is public information that they will be able to share with you.
- Member’s Full Name and Date of Birth – If you are calling on benefits for yourself, you will need to provide your name and date of birth. If you are calling on behalf of a child or spouse, you will need their full name and date of birth.
- CPT Codes – CPT codes are the codes the medical office sends to the insurance company to tell the insurance company what was done that visit. These aren’t always necessary, but they are nice to have that way you can get the most accurate information possible.
- Diagnosis Codes – These are codes that the medical office and insurance company have chosen to represent a specific diagnosis. These are like the CPT codes, not necessary but nice to have.
Filing an Insurance Claim for Therapy Services
Other information that may be needed to discuss a specific claim, denial, or issue could be:
- Providers NPI Number – You can get your provider’s NPI Number by calling the office and asking for it. It is public information that they will be able to share with you.
- CPT Codes – CPT codes are the codes the medical office sends to the insurance company to tell the insurance company what was done that visit. These aren’t always necessary, but they are nice to have that way you can get the most accurate information possible.
- Diagnosis Codes – These are codes that the medical office and insurance company have chosen to represent a specific diagnosis. These are like the CPT codes, not necessary but nice to have.
Common Insurance Questions to Ask With Regards to Therapy Services
When calling your insurance company in regards to therapy services, these are some things to ask while you are on the phone with them. These questions will not only make the process of getting started for therapy services quicker, but it will also make it so there are no surprises when/if you receive a statement from the therapy provider!
- Is this provider in-network with my policy? – This question will inform you if your provider is contracted with your insurance company. If your provider is in-network, it will lead to less patient responsibility.
- Is OT/PT/SLP covered under my policy? – Just because you have insurance doesn’t always necessarily mean that therapy is covered, it’s all policy specific.
- How much is my deductible and how much do I have remaining on my deductible? – This will let you know how much you have left to pay before insurance starts to pick up a portion of the balance.
- What will my costs be after my deductible has been met? – Just because you have met your deductible does not always mean that you will not have a cost at all. Typically, it is a small cost. Whether it’s a copay or a coinsurance which is just a percentage (usually 10%-30%).
- Do I have a set number of visits for this specific therapy? – Some insurance companies will only cover a set number of visits, others will not have a visit limit and will be covered under the insurance policy if it is medically necessary. If you do have a visit limit it’s always a good idea to check to see if you have already used any of those visits.
- Are telehealth services covered? – Since Covid-19 has been around, something that is becoming more popular is telehealth services. This is just doing your therapy, if possible, online. Whether you use this service because you are sick or just don’t feel like coming in, it is always a good idea to make sure it’s covered by your insurance company.
Altogether, it is important to know your benefits when calling to start therapy services. It may seem intimidating, but these are your health benefits and you should be kept in the know! If after reading this, you are still unsure what to ask the insurance company, please contact our office at (814) 464-0627 or email info@niagaratherapyllc.com and we will be able to help you get started!
