Insurance and Payments
Pediatric Hands on Therapy, PC accepts direct insurance reimbursement from the following companies:
- Blue Cross/Blue Shield of NC (We do not accept Blue Local)
- Blue Cross/Blue Shield out of state
- Cigna (out of network)
- United Healthcare
- Medicaid (see upcoming changes below)
- Health Choice
If you are not a member of any of these insurance companies we do offer a private pay rate. Please contact our office to discuss rates.
What is a covered service?
Many insurance companies will list speech therapy, physical therapy, or occupational therapy as a covered service. While physical and occupational therapy is usually covered, speech therapy is often NOT. Please be aware that insurance companies will include a clause “when medically necessary to restore speech functioning following illness or injury.” Insurance companies will cover speech therapy in the case of language lost due to an injury or medical condition. This does not include developmental disorders of speech. Sometimes an insurance company will inform you or our office staff over the phone that your child will be covered for speech therapy, due to the specific diagnosis they may not cover the therapy once it has been submitted. It will be beneficial to receive the coverage in writing prior to starting therapy.
If you have any questions or concerns our office staff will be glad to verify benefits for you.
How Much Will Be Reimbursed?
Every insurance company and benefit plan is different. We will be happy to verify benefits for you. The majority of the time therapy sessions will be covered. However, the therapy session will be covered but the cost will be added to the deductible if your deductible has not been met. In this case, you will be responsible for the cost of the therapy session. If you have a co-pay for therapy sessions the co-pay is due at the time of service.
Pediatric Hands on Therapy, PC strives to provide the therapy each child needs. We will be happy to work with families with different payment options. Please contact our office with any questions or concerns.
We would like to inform our families of the upcoming Medicaid changes, so you can continue to receive coverage for our services. As of July 1st, 2021 a Medicaid Transformation known as the NC Medicaid Managed Care Program will go into effect. Under this new program, the state will be contracting with insurance companies to form health plans. Five health plans will be available with each being different to better match families to plans that will provide them with the best care and coverage possible. Families should research which will be best for them and make a decision between now and May 14th. After May 14th, recipients who have not chosen a plan will be assigned one. Pediatric Hands On Therapy will be accepting all five health plans under the new NC Medicaid Transformation. To explore your options, see exclusions, or for more information, you can visit the NC Medicaid site by clicking here. They also have a phone line to assist you – please call 919-527-6666. As always, we are here to help answer any questions we can.