Are services covered by insurance?
Some medical insurance policies will cover Speech/Language services, Occupational Therapy and ABA Therapy; however every insurance plan is different. It is a good idea to contact your insurance carrier to determine if your plan covers Speech, Occupational and/or ABA Therapy. The following questions may be helpful when contacting your insurance carrier:
- Does my policy include a speech therapy benefit?
- Are there any exclusions to my policy?
- Is there a limit on the number of visits you will cover?
- Do I need to bring a referral, prescription, or authorization to my evaluation in order to be covered?
- Do I need a referral, prescription, or authorization for coverage of ongoing therapy sessions?
- Do I have a co-pay or co-insurance? If so, how much for a specialist?
- Do I have a deductible? Have I met my deductible? How much of the deductible is remaining?
- Do I need a letter of medical necessity from my physician?
*Please note that according to the fine print in most insurance policies, having a speech therapy benefit does NOT guarantee payment. Services rendered and not covered by insurance, may be the patient’s responsibility.
What insurance does National Therapy Center take?
- Aetna/Coventry (ABA Only)
- AmeriGroup
- AmeriHealth
- CareFirst (ABA Only)
- DCEI
- HSCSN
- Kaiser Permanente
- Maryland Medicaid (ST and OT Only)
- Montgomery Coutny Dept. of Health and Human Services (ABA Only)
- Humana Military (TriCare)
- Trusted Health Plan
- Virginia Medicaid (ST and OT Only)
What if National Therapy Center does not take my insurance?
If you carry insurance that National Therapy Center does not accept, you are still able to receive services. We recommend that you contact your insurance carrier and inquire about your out of network benefits. If you determine that you qualify for out of network reimbursement, National Therapy Center will provide you an itemized statement at the end of each month.
What is a GAP Exception and/or am I eligible?
Gap exceptions are granted when you can prove that your policy's in-network provider list does not include a service provider that can meet the needs of your family. You may qualify if you can provide evidence that your in-network provider list does not include one of the specialties that we provide in our specialty clinics; Stuttering/Fluency, Feeding, AAC and Autism.
If you receive a gap exception, you will still be required to pay out-of-pocket, however your insurance company may reimburse you directly at your plan's in-network rate (which is often a higher rate than you would receive using your out-of-network plan). The "gap exception" process varies among insurance companies, so you will need to contact your insurance company to learn more.
If you need assistance in getting started with a gap exception, contact Brooke Leiman or call our Bethesda office at (301) 493-0023.
If you receive a gap exception, you will still be required to pay out-of-pocket, however your insurance company may reimburse you directly at your plan's in-network rate (which is often a higher rate than you would receive using your out-of-network plan). The "gap exception" process varies among insurance companies, so you will need to contact your insurance company to learn more.
If you need assistance in getting started with a gap exception, contact Brooke Leiman or call our Bethesda office at (301) 493-0023.
National Therapy Center
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Capitol Hill Office
Headquarters 412 1st Street SE. Rear Building-Lower Level Washington, DC 20003 Tel: (202) 470-4185 Fax: (202) 741-9952 CBE Certification#: LS87265122021
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Maryland Offices:
5606 Shields Drive Bethesda, MD 20817 Tel: (301) 493-0023 Fax: (301) 493-8230 20400 Observation Drive, #104 Germantown, MD 20876 Tel: (301) 540-0445 Fax: (301) 540-0766 |
Virginia Offices:
Arlington, VA Reston, VA Tysons Corner, VA Call to inquire about services: (301) 493-0023 |