KM Pediatric Therapy, Inc. is an in-network provider for Aetna, Blue Cross Blue Shield, United Healthcare, Cigna, Medicaid/NC Healthchoice, BCBS NC State Health Plan, Medcost and Friday Health Plan. We are contracted providers with the Raleigh and Durham Children’s Developmental Services Agencies (CDSA). KM Pediatric Therapy, Inc. is also a participating provider with BCBS Healthy Blue, AmeriHealth Caritas, United Healthcare Community Plan, WellCare, Carolina Complete Health, Alliance, Vaya and Trillium. Our in-network status does not guarantee that services will be covered by your insurance plan. It is important that you understand your individual benefits as they pertain to speech, feeding and/or occupational therapy services. It is your responsibility as the policyholder to contact your insurance company to find out if speech, feeding and/or occupational therapy is a covered service under your policy and whether you have any exclusions or visit limits. KM Pediatric Therapy, Inc. is not responsible for obtaining or tracking benefit information. It is your responsibility to provide KM Pediatric Therapy, Inc. with a copy of the front and back of your current insurance card so we can determine if prior authorization is needed for your child’s services.
Billing:
KM Pediatric Therapy, Inc. will submit claims to your insurance company. While we will assist in filing claims, payment for all services is ultimately charged to you, not to your insurance company. Parents/guardians are responsible for payment of any portion not covered, or denied, by insurance. Statements for services are mailed around the 1st of each month. Payment is due by the due date listed on your Statement. In the event that payment is not received in full and on time, then a $25 late fee will be added to unpaid accounts every 15 days until payment is made. Also, if payment is late, your child’s services may be placed on hold, or terminated. Please note that if services are placed on hold, we cannot guarantee your time slot will be held. In the event collection efforts are necessary, then any costs incurred, including attorney’s fees and court costs shall also be due and payable as part of any post due amount.
PAYMENT OPTIONS:
- Credit Cards/HSA or FSA Cards: If paying by credit card, you must complete the Credit Card Recurring Payment Authorization Form. Credit card information will be stored on a secure credit card system. Your credit card will be charged the balance amount listed on your Statement around the 15th of every month.If your credit card denies, you will be notified by KM Pediatric Therapy via email. If within 5 business days we have not received a valid credit card or check payment, your child will be placed on hold until account is paid in full.
- Checks: Checks must be mailed and received in the office no later than 5 business days from the Statement due date. If not received within this timeframe, your child will be placed on hold until account is paid in full. A $25 fee will be charged for checks with insufficient funds.
CLAIM PROCESSING AND DENIALS:
KM Pediatric Therapy, Inc. is NOT responsible for claim denials. KM Pediatric Therapy, Inc. will not enter into a dispute between you and your insurance provider regarding a claim. Please be advised that insurance companies process claims according to their own timelines, independent of KM Pediatric Therapy, Inc. Some companies will take 30-45 days before providing their initial response. If your insurance company requests medical records, we will fax or mail those to your insurance company but it is up to you to follow-up with the claim. If the claim remains unresolved after 60 days following the initial claim submission date, the parent/guardian will be billed the estimated charge of services provided. If your insurance eventually processes the claim and it results in a change of financial responsibility, KM Pediatric Therapy, Inc. will either bill or refund the parent/guardian the difference.
CHANGES IN YOUR INSURANCE COVERAGE:
It is your responsibility to inform KM Pediatric Therapy, Inc. of any and all changes of insurance coverage during the course of treatment, including changes in your address, phone number, employment and medical benefits. Failure to provide this information will result in the parents/guardians being responsible for payment of all non-covered and/or unauthorized services that may result.
COMMON INSURANCE TERMS:
- EOB—Explanation of Benefits: Your insurance company will provide you this documentation that explains your financial responsibility per claim.
- Deductible: The amount you must pay for health care before your insurance benefits take effect.
- Coinsurance: The percentage of health care costs you must pay once your insurer covers its share. Coinsurance typically goes into effect once the deductible has been reached.
- Copay: The set amount you must pay for a health care service.
APPEALS PROCESS:
The appeals process is between you and your insurance provider, and not KM Pediatric Therapy, Inc. However, we can assist in providing you with clinical documentation. You will be responsible for submitting the documentation to your insurance provider and any follow up communication required. During the appeals process, KM Pediatric Therapy, Inc. is not receiving payment from your insurance provider. This in turn will result in you paying in full for the treatment sessions your child receives. If you cannot pay in full for the treatment sessions, therapy will be placed on hold until the appeals process is complete.
MISSED APPOINTMENTS:
All client cancellations require at least a 48 hour notice. Cancellations without a 48 hour notice will incur a $25 missed appointment fee which is not covered by insurance. Special consideration may be given to emergency situations and/or illness. Children who receive services through Early Intervention (CDSA) or who have Medicaid cannot be charged this fee but we still ask for advanced notice for any missed appointments. If you repeatedly miss your scheduled appointments, the therapist has the right to discontinue services. Please refer to the KM Pediatric Therapy Cancellation Policy for specific details.
CANCELLATION POLICY:
The following cancellation policy has been adopted by KM Pediatric Therapy, Inc. to be applied to all scheduled evaluation and therapy appointments. This policy is enforced in order to be respectful of your work schedule, personal schedule and that of our therapists. It is also important that service delivery is consistent in order to elicit the progress that is important for your child and required, per insurance regulations, for ongoing therapy to remain justifiable. By maintaining the prescribed and agreed upon frequency of treatment, your child will optimize their benefit from the provided skilled intervention and the duration of therapy can occur at its most efficient length.
- Planned Cancellations: (e.g., doctor’s appointment, vacation) It is the parent/caregiver’s responsibility to keep the therapist informed of any changes needed to the therapy schedule. A 48-hour notice is required for any cancellations so that adjustments can be made to the evaluation/therapy schedule and make up sessions can be accommodated, if possible.
- Cancellations due to Illness: It is vital that parents and therapists work together to keep each other healthy and safe. Our therapists travel from patient to patient and some of our patients, or their close family members, are vulnerable to medical complications should they be exposed to contagious diseases. Please cancel your scheduled appointment should your child experience diarrhea, vomiting, contagious disease, or a fever of over 100 degrees. Your child should be symptom free for at least 24 hours before therapy can resume. Our therapists will also notify you if they experience illness and are unable to provide services.
- No Shows or Tardiness: In the event of a “no show” (i.e., not being home or at daycare/preschool at the scheduled time or not logging into a virtual session at the scheduled time) or tardiness (later than 15 minutes past your scheduled appointment time), you will be given written notice. A second no show or tardy within a 3-month period will result in your child being discharged from our practice. Parents must keep 75% of scheduled therapy visits per month. Clients who drop below this amount for 2 consecutive months will be given written notice of discharge from our practice. Our therapists will make every effort to accommodate a reschedule should a cancellation be required.
- Copay: The set amount you must pay for a health care service.
