COMMON QUESTIONS.

While we are not in network with any insurance companies, we do have a billing partner who will call your insurance company to gather information about your insurance benefits. They will contact you to explain your benefits and the billing process in more detail ahead of your first appointment. Our billing department will also obtain any necessary authorizations so that your child can be evaluated or receive ongoing therapy at our practice. Finally, each time your child is seen at our office they will submit claims electronically on your behalf. Any balance on your account will not be collected until after insurance processes each claim.

Sensational Kids Therapy is an out-of-network provider. However, we understand the difficulties families have with navigating the insurance world. As such, rather than providing families with a superbill each month to submit on their own, we have a third-party billing company who will take care of securing authorizations, submitting claims directly to your insurance company and follow-up on any denials so that every dollar is collected within the parameters of your plan.

We know your time is valuable. We prioritize parents spending time with their child to maximize therapy efforts over dealing with their insurance company. In addition, being out-of-network allows us more flexibility in how we individualize treatment for your child and how we deliver therapeutic services. We can focus on what is most important to families rather than what the insurance company dictates as a covered service. Our billing company is a separate entity so that clinicians are not tasked with copious amounts of paperwork which distracts from intervention. Finally, discharge is determined by the therapist in collaboration with the family rather than when the insurance company dictates.

If an evaluation is recommended during our free intake call, Lisa or Shiraz will collect your insurance information and submit it to the third-party billing company. They will give your insurance company a call to verify your plan is active and learn what your out-of-network benefits entail. For example, the insurance company may provide information as to the number of visits allotted per year, your deductible amount and the percentage of the allowable amount that will be covered. This information will be communicated to you via email so that you have the plan details to review at your convenience.

Our experience is that insurance companies are difficult to navigate for the average consumer. When we previously provided superbills to families, there were many denials due to not submitting claims in a timely manner and not obtaining the proper authorization ahead of starting therapy. Once a claim is denied, it takes many hours to sort out the reason for the denial and understand the process for resubmitting the claim. In many cases, claims are not eligible for resubmission if the authorization was not obtained ahead of those visits. Our therapists were spending time on the phone with a patient’s insurance company to try to sort out the issues which distracted from time spent on treatment planning and clinical communication with families. In 2016, we opted to partner with a billing company so that this would be a smoother process for families and to ensure they were entitled to the full eligibilities per their plan documents. Our billing company is a local company located in Lorton, Va. They are accessible by phone and email during East Coast business hours for any insurance or billing questions.