Insurance Policy Information

In an effort to help families with insurance reimbursement for therapy expenses, Skills on the Hill will obtain authorizations for therapy services (when required) and submit claims electronically to your insurance carrier on your behalf.  This does not mean we have a contract with every insurance, as we are still Out-Of-Network with most insurance.  However, your claims submission will be timely and our billing department will follow-up on any unpaid claims issues.  After insurance reimbursement, you will never be out-of-pocket more than our current self-pay rate for services (please see attached Fee Schedule)

Using the Verification of Benefits form, our billing office will verify your insurance benefits and talk to you about them via phone.  Our billing staff is experienced with therapy services and they will be able to answer all of your questions related to benefits, claims processing, as well as your billing statements.  Please be available to them so that you can have all of your questions answered.

You will not be billed until your claim has been processed by your insurance.  You will receive a statement from us every 28 days if you have a balance due. You will then have (5) days to review the statement and call the billing department with any questions/concerns about the charges. Unless there are corrections, your credit card will be charged for the full amount shown on your statement.

For all questions related to your claims and billing statements for services, please contact our Billing Office at 202-424-2718    or skills@hspmd.com.  Our regular therapy staff will not be able to answer your questions or discuss your insurance claims or your statements as they are not involved with the insurance processing.

For our BCBS families:  In most cases, the payment for services will be sent directly to you.  Please be looking for your payment and deposit the check directly into your bank account. The billing office will verify with the insurance company the specific amount of the reimbursement paid to you, then they will send you a statement to reflect payments and charge your credit card.

It is our pleasure to provide high quality pediatric OT services to your child(ren).  We know that submitting the claims to your insurance for you relieves you of having to work on your own for insurance reimbursement.

 

Policy for Secondary Insurance:

  • You MUST inform our billing office if your child has more than one insurance policy. The practice will verify with both policies to confirm which policy is primary.  This is critical to getting any necessary authorizations and having your claims process correctly.
  • Please be aware that, if you have or decide to obtain secondary insurance, one plan will be primary for ALL claims.  The determination of which plan is primary and whether any payment would be made by a secondary plan depends on the rules specified in each insurance plan.
  • Keep in mind that our practice WILL NOT bill secondary insurance for you. You can use your primary insurance EOB/EOP (billing statement) to submit to your secondary insurance per your secondary insurance instructions.
  • If you do not notify our billing office of more than one policy, you may end up being responsible for the cost of any services that are denied or processed incorrectly.

Policy for GAP Coverage: (This is also known as “In for Out” “Single Case Agreement” and “Network Deficiency”)

  • If you have Out of Network benefits, our practice WILL NOT file claims under GAP coverage. Your Out of Network benefits will cover you and we will submit and follow-up your claims under your Out of Network Benefits.
  • If you have out of network benefits and you still want to obtain and use GAP coverage, you will be responsible for filing your own claims and obtaining any required authorizations for service.  When there are out of network benefits under your policy, GAP coverage creates a delay in claims processing that our practice cannot afford to manage.
  • In this case, you will be billed directly for services and your credit card will be charged according to the balance due on your statement.  You may use your billing statement to submit to insurance for reimbursement.  Your insurance may also have its own forms to submit in addition to your billing statement.
  • If you DO NOT have Out of Network benefits under your policy (i.e. you have an HMO and are not allowed to go out of network) and you want to obtain GAP coverage so that you can come to Skills on the Hill, you will be billed directly for services and your credit card will be charged according to the balance due on your statement. You may use your billing statement to submit to insurance for reimbursement.  Your insurance may also have its own forms to submit in addition to your billing statement.

For questions, please contact our Billing Department at 202-424-2718 or skills@hspmd.com

 

INSURANCE VERIFICATION OF BENEFITS

*** An Insurance Verification of Benefits (VOB) Form must be completed and submitted within 48 hours to scheduling an appointment at SOTH. You may submit the form to our billing department via email (skills@hspmd.com) or fax to 301-668-7008.

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