In-Network vs. Out-of-Network Therapy with Billing Company Support vs. Out-of-Network Therapy with Superbill
When making a decision about a therapy practice, it is important to understand the pros and cons of each model. Sensational Kids Therapy uses a hybrid model where we remain out-of-network but use a third-party billing company so that families can focus on home therapy programming rather than navigating the insurance piece.
In-Network Therapy: Pros and Cons
Pros:
Services apply to deductible
Claims submitted directly to insurance company
Co-pays due at time of service
May be less costly for families
No authorization needed
Cons:
Limited time to perform initial evaluation
Evaluation reports are brief and often lack interpretation
Insurance company determines if the gap is significant enough to warrant therapy
Insurance company determines when discharge is appropriate
Family is responsible for following up on denied claims
Out-of-Network Therapy with Billing Company Support: Pros and Cons
Pros:
Services apply to deductible
Claims submitted directly to insurance company
Billing company will obtain authorization and follow-up on denied claims
Payment due after insurance company pays the covered amount
Comprehensive evaluations with narrative written report
Treatment plans are individualized to the child and not subject to insurance parameters
Therapist and family determine initiation of services and discharge
Cons:
Financial responsibility may be more than co-pay
Out-of-Network Therapy with Superbill
Pros:
Services apply to deductible
Comprehensive evaluations with narrative written report
Treatment plans are individualized to the child and not subject to insurance parameters
Therapist and family determine initiation of services and discharge
Cons:
Financial responsibility may be more than co-pay
Full cost of services due monthly, any reimbursement from insurance takes time to receive
Family must obtain authorization and track visits
Family must submit superbill to insurance company
Family must follow-up on denied claims
Choosing a practice requires consideration of the pros and cons of each model. While we have chosen to remain out-of-network to maintain the highest level of care, we recognize that families don’t need the additional burden of managing the insurance side. Our billing company partner works on your behalf to help navigate the insurance process and helps us concentrate on providing the best therapy service. We are always available to answer questions about our model at office@sensationalkids-therapy.com or (202) 244-8089, ext. 1.
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