Billing

At this time, we do not accept Medicaid plans. If Medicaid is your primary insurance, you would be responsible for the self-pay rate of $350.00 for evaluations and $100.00 per treatment session.

At this time, we do not accept Medicaid plans. If Medicaid is your primary insurance, you would be responsible for Montclair Speech Therapy’s self-pay rates.

We are in-network with select insurance plans:

• Horizon BCBS
• Aetna (Speech Therapy)
• Medicare
• Cigna

Please note: We are out-of-network with Aetna for Occupational Therapy services. If you have an Aetna plan and are seeking Occupational Therapy, services would be considered out-of-network and billed at our self-pay rate. You may choose to submit a superbill to Aetna for possible reimbursement if your plan includes out-of-network benefits.

Being in-network means we have a contract with your insurance company. This agreement establishes:

• The negotiated rate for services
• Your copay, coinsurance, or deductible responsibilities
• The claims submission process

If we are in-network with your plan:

• We bill your insurance directly
• You are responsible only for the portion determined by your insurance (copay, coinsurance, or deductible)
• You benefit from reduced, contracted rates

If we are out-of-network with your insurance plan, we do not have a contract with your insurer. However, you may still have out-of-network benefits. In this case:

• Self-pay rates may differ per client
• Depending on the insurance plan, we will submit the claim to your insurance, with the exception of Occupational Therapy under AETNA.
• Reimbursement amounts vary by plan

Self-pay or private pay means we do not bill insurance directly, and clients pay the full session fee at the time of service. Some clients choose private pay because:

• They prefer not to involve insurance
• Insurance requires a diagnosis
• They want greater privacy
• They want flexibility without session limits or authorization requirements
• They exhausted out visit limits

An authorization is approval from your insurance company for specific healthcare services. Some insurance plans require authorization before therapy can begin or before additional visits can be provided. Our billing team will work with your insurance company to obtain authorization when required.

Please note: Receiving authorization does not guarantee that your insurance will cover the services.

A visit limit is the maximum number of therapy visits your insurance plan will cover during a specific period, such as a calendar year. Visit limits vary by insurance plan and may depend on the type of therapy, diagnosis, and how your insurance company processes and applies claims to your benefits. Some plans may have separate visit limits for different therapy services or diagnoses.

Our billing team will help monitor authorized visits when possible, but it is ultimately the responsibility of the insurance plan to determine coverage and how visits are applied to your benefits.

The best way to understand your benefits is to call the member services number on the back of your insurance card. Helpful questions to ask include:

• Is this provider in-network or out-of-network?
• What is my deductible, and have I met it?
• What is my copay or coinsurance per visit?
• Do I have out-of-network benefits?
• How many visits per year are covered?
• Is prior authorization required?

We assist with benefit verification. However, verifying coverage does not guarantee payment by your insurance company.

Your out-of-pocket costs depend on your specific insurance plan. You may be responsible for:

• A copay (a fixed amount per visit)
• Coinsurance (a percentage of the allowed amount)
• The full session fee until your deductible is met
• Any balance not covered by insurance

Payment is due at the time of service unless prior arrangements have been made.

A copay (copayment) is a fixed amount you pay at each visit, as determined by your insurance plan.

If you have primary and secondary insurance, please provide our office with the current information for both insurance plans. One plan will be designated as your primary insurance, and the other as your secondary insurance through a process called Coordination of Benefits (COB).

Your primary insurance is billed first. Once the primary insurance processes the claim, the remaining balance may be submitted to your secondary insurance, which may cover some or all of the remaining balance depending on your plan’s benefits.

Insurance companies follow specific guidelines to determine which plan is primary. If you are unsure which plan is primary or how your benefits coordinate, please contact your insurance companies directly to confirm your coverage and coordination of benefits.

If your insurance company denies coverage, our billing team will review the denial and determine the appropriate next steps.

Our billing team also monitors the number of visits allowed by your insurance plan. When you reach your plan’s visit limit, our team will determine whether a predetermination for additional visits can be submitted to your insurance company for review.

Please note: Submitting a predetermination does not guarantee that additional visits will be approved or that your insurance company will provide payment or coverage for those services. Our billing team will communicate with you regarding the status of your coverage and any applicable next steps.