Understanding your Explanation of Benefits: Understanding your Explanation of Benefits (EOB) for Children’s Speech, Occupational or Physical Therapy is important to ensure that your insurance is working. And above all, to eliminate surprises that result in unexpected expenses.
Keeping track of denials: Many times the insured (you) gets the EOB in the mail before the provider (BDI). Therefore, if you see something that doesn’t look right, you can call your insurance or your pediatric therapy billing office right away, before you accumulate a large bill you might not be prepared for.
Look for accuracy: It is in your best interest to watch your EOBs from your insurance to verify services are accurate. Noticing an error can be brought to your provider’s attention sooner so it can be corrected immediately.
Reading an explanation of benefits (EOB) from your insurance for your child’s pediatric therapy can be a little confusing at times. Some pediatric therapies use the same or similar codes for treatment. These are called CPT codes. A CPT code is the code assigned to the therapy to describe the type of therapy your child had.
The office will bill a set rate (or charge) to your insurance for those CPT codes. If our company has a contract with your insurance; a discount might be offered and included on your EOB. Based on your benefits, you would be responsible for any unmet deductible, coinsurance, or copay.
3-Your insurance allowed this amount for that service, based on our contract with them, if any.
4-The amount your insurance paid the company based on your policy benefits.
5-Name of the organization that was paid for the service (BDI, or Bautz Developmental Intervention)
6-What your financial responsibility is for this date of service based on your policy benefits. (This would be deductible, copay or coinsurance portion.)
7-The reason for any non-payment or adjustment (reduction in payment) that was made.
Our goal is to make funding for your insurance as stress-free as possible. If you need additional help, we are only a phone call or email away! Our patient families can reach us at office@bdiplayhouse.com or 708-478-1820.
Written by:
Ann Marie Johnson
BDI Playhouse Insurance Billing Specialist and Assistant Office Manager
Providing the best services for your child requires a HIGHLY TRAINED TEAM of therapists AND office professionals.
Our knowledgeable office team provides information and guidance to streamline and support processes that save your precious family-time. Securing coverage or providing a plan that allows your child to receive uninterrupted QUALITY services is our goal.
If you have questions, we have answers. Call us any time or schedule a call with our office at a time that is convenient for you HERE.
100+ years of combined office and billing experience
For general information related to coverage guidelines that commonly apply, please select your insurance below:
Blue Cross Blue Shield
BDI Playhouse is in-network with BCBS PPO plans.
BDI is in network with a select number of BCBS HMO Plans. See our HMO Plans tab below for more info.
Most plans have generous Pediatric Therapy benefits.
Some plans limit coverage so please check with your carrier for any limitations on your policy. If coverage cannot be secured, please consider our private pay discount rates.
Aetna
Most Aetna plans only cover speech therapy when it directly relates to a birth defect, brain injury, stroke, or head trauma. Review Aetna’s policy regarding Speech-Therapy coverage for more information.
Aetna does not cover the cost of Aquatic therapy. BDI offers a Private Pay rate if services are not covered. Private pay rates can viewed by clicking the button below.
Aetna allows one appointment maximum per day.
While your plan may have an annual visit allowance, that is not considered a guarantee of coverage. Coverage of services is always dependent on medical necessity, not the policy’s annual visit limit.
If coverage cannot be secured, please consider our private pay discount rates. To view rates, please click the button below.
In the event that insurance funding is not available, or services are limited or not covered by the policy, our private pay discount rate offers parents another option. Details on the discount for our affordable private pay rate options can be found by clicking the button below.
Early Intervention (EI) is a state-funded program offering services to children birth to age three with a qualifying level of delay or qualifying diagnosis.
EI serves as a secondary insurance: Providers bill your insurance first and then Early Intervention for portions not covered by your plan.
A monthly family fee typically applies
Services are often required (by the program) to be provided in the family’s home and children with this funding source are rarely approved for services in-clinic at BDI.
Many families receive services BOTH through the Early Intervention AND separately through their insurance so that they may receive services in clinic, allowing the best of both worlds in their child’s intervention.
Waiting periods in Early Intervention are common. We recommend scheduling a free screening or consultation at BDI Playhouse prior to starting the Early Intervention evaluation process, as we can typically schedule within one week. We can also offer services temporarily while you wait for Early Intervention to complete the initial evaluations, schedule a meeting to generate the service document called an IFSP, and assign treating therapists.
More detailed information regarding this program can be found here.
Please review the Early Intervention website, but do not hesitate to ask us to walk you through how the Early Intervention Program works and how accessing this resource might benefit your family.
Cigna
BDI Playhouse is not in-network with Cigna.
Therapy can be billed to Cigna and will process to your Out of Network benefits
Specific billing codes can be provided to help you confirm coverage.
We offer significantly discounted private pay rates. To view rates, please click the button below.
As of January 1, 2025, BDI is a part of Duly Health and Care HMO Organization (formerly DuPage Medical): HMO of Illinois Blue Advantage HMO Blue Precision HMO
For other HMOs ask your child’s pediatrician to provide assistance in requesting a “single case agreement or waiver” to allow for coverage outside the network, at your in-network level of benefits. Click here for instructions to begin that process.
If coverage cannot be secured, please consider our private pay discount rates. To view rates, please click the button below.
BDI is not contracted with Government supported plans such as Medicaid or any State-funded plans (Illinois Medicaid, BCBS Community, Illinicare, Meridian, Health Alliance, Aetna Better Health, County Care, etc).
We offer significantly discounted private pay rates. To view rates, please click the button below.
