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Tag: EOB

Understanding Your Explanation of Benefits (EOB) for Pediatric Therapy

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

1-What services were performed.

2-The amount that was billed to your insurance.

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

Insurance & Billing For Current Clients

Insurance and Billing Information

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

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Insurance & Billing For New Clients

Insurance & Billing For New Clients

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 not in-network with BCBS HMO plans.
    • Most plans have generous Pediatric Therapy benefits.
    • Some plans limit coverage so please check with your carrier for any limitations on your policy.
  • 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. 
    • 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.

     

     

  • United Healthcare

    • BDI Playhouse is not in-network with United Health Care Plans. 
      • Therapy can be billed to UHC and will process to your Out of Network benefits
      • Specific billing codes can be provided to help you confirm coverage.
  • Private Pay Discount Details

    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 here.

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  • Early Intervention Funding

    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

    Starting January 1, 2023, BDI Playhouse will not be in-network with Cigna PPO plans. 

    • 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.
  • Other Insurance Plans

  • Multiplan Network participant: offers a 10% discount for Out of Network claims

 

Claims billed to any other insurance plan would process to your Out of Network benefits coverage.

  • HMO Plans

    • We are contracted BCBS Ingalls 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. 
  • Medicaid and State Plans

    • 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 a significantly discounted private pay rate. Please see the attached link for more information.

     

  • DSCC

    • DSCC: is the Division of Specialized Care for Children
    • Financially assists IL families and Children with special healthcare needs
    • Acts as a secondary insurance and often covers what primary insurance doesn’t
    • Eligibility is determined by family income and  the diagnosis or needs of the child

     

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