Everyone Deserves A Voice

Step 1: Getting Informed:

Insurance companies use some “creative” ways to determine the basis of what they will cover based upon what they say therapy should cost, otherwise known as the reasonable market value, not on the actual amount charged. Alternatively, they may use a percentage of Medicare rates as the basis for what they will reimburse, even if you aren’t eligible for Medicare.

Thanks to numerous class action lawsuits, and legislative work on healthcare laws, there is a consumer rights website, Fair Health Consumer, where you can see what an objective source says the typical fees are in your area. In order to use the site;

1. Enter the zip code in which you received services.
2. Enter the procedure code
3. Click “See Out-of-Network Reimbursement”
4. Scroll down to “Cost Breakdown” 

Now that you have the local rates for your area, you can call your insurer.

As an important note, when determining costs of services, Cy-Fair Speech, LLC relies on the Fair Health Consumer site to determine local costs for the zip codes surrounding 77433 where Cy-Fair Speech, LLC is headquartered.

Step 2: Call the Insurance Company

Find out what they agree to pay and determine your deductible (generally a percentage is covered under your policy).

Next, you would tell them what you expect for reimbursement for therapy. For example, you’d tell the insurer that you are submitting claims for therapy, CPT XXX at a rate of XXX and provide your zip code as and inform them that the provider, Cy-Fair Speech, LLC, is a licensed speech therapist provider and that they are a non-participating provider (meaning I have chosen not to “contract” with any insurance companies). 

Ask your insurance provider if the therapist’s fee is within the range of what they use to determine reimbursement. If they say no, provide them the details from the Fair Health Consumer website.

Filing a Claim Online

1. Sign into your health insurance company’s website
2. Find “Submit a Claim Online”
3. Fill in the requested information
   1. Provider’s name (Cy-Fair Speech, LLC) and address (12423 Shorelands Road, Cypress, Texas 77433)
   2. EIN (88-0940546)
   3. Diagnostic Code (ICD)
   4. Procedure Code (CPT)
4. Scan and upload a copy of your therapist’s notes and invoice

Filing a Claim by Mail

If you are not able to file your claim for reimbursement online, you may file a paper claim form, attach a copy of your therapist’s bill, and mail it to your insurance company.

You can find the claim form on your insurance company’s website, where you can print it out. If you have already paid and you are filing for reimbursement, write in bold letter and highlight on the form that “PATIENT HAS ALREADY PAID PROVIDER - PLEASE REIMBURSE PATIENT”

1. Diagnosis - You’ll enter this as a code, which will be located on your invoice with an abbreviated code.
2. Place of Service - Enter home, code XX
3. Description of Services - CPT is the code for what kind of service your therapist provided, and should be on your therapist's invoice, for example, “XXX” is “CPT XXX”
4. Your therapist’s NPI
5. Provider’s Signature - Fill this in with “See Attached Invoice”. Most of the time, this is sufficient.
6. Assignment - Do not sign anything that says “authorized assignment”, since you have already paid your therapist and are filing for reimbursement. If you authorize or assign your benefit, that means the insurance company will attempt to send the reimbursement to the therapist instead of you.