For New Families
Intake Process and Payment Information
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To begin pediatric services:
1. Please call (440) 285-0775 and let us know that you are seeking services for your child. Please note that we must speak with the parent or legal guardian to initiate services.
2. When you call, front office staff will collect some basic information:
your child’s name, age, date of birth, and other relevant information (e.g., referral source, school, evaluation and therapy history, diagnoses)
your name and contact information
main concerns about your child’s speech and language development
whether your child has an IEP through a school district
days and times your child is available for evaluation and/or therapy
3. The information you provide will then be reviewed by Nancy Theofrastous, WRSLP Owner and Clinical Supervisor. She will either call you to collect more information, or you will be contacted to set up your child’s first appointment and discuss options for regular appointments.
4. Once a first appointment is scheduled, we will mail registration and case history forms to the parent or guardian who contacted our office. Parents/guardians complete the forms at home and bring them to the first appointment. We also ask that you bring any recent reports about your child to your first visit (e.g., ETR, IEP, hearing assessment, neuropsychological evaluation).
Paying for our services:
JPSN:
WRSLP is a Jon Peterson Special Needs (JPSN) Scholarship Provider. JPSN funding is available through the Ohio Department of Education to children in kindergarten through high school who are homeschooled or educated in non-public schools AND have an IEP (Individualized Education Program). For more information, please visit the JPSN information page by clicking here.
Insurance Networks:
Due to the high administrative costs associated with participation in insurance networks, WRSLP has ended its participation in all insurance networks. Because we are committed to keeping costs down so that more families can afford speech-language therapy, WRSLP’s self-pay rates are often lower than what insured patients pay at local hospital systems and larger practices, so we encourage you to price shop. (See Insurance Tips below.)
Self-Pay:
If neither JPSN nor health insurance will cover speech and language services for your child, refer to the fee schedule (page 2 of the Registration Form you receive in the mail before your first appointment) or call our office (440-285-0775) to ask about the cost of our services. “Self-pay” families are responsible for the full cost of each service.
Insurance Tips:
In order to compare our cost to what you would pay if filing with insurance through another provider, you need to fully understand your insurance coverage. Some major hospital systems and insurance carriers have tools available to patients that help them determine the likely cost of services. Be sure to use those tools and don’t hesitate to call your insurance company to collect the following information.
Information to gather:
Diagnoses and services your insurance carrier covers: Not all speech-languagee evaluation and therapy services are covered by all carriers. Some carriers, for example, do not cover delays and disorders they consider to be “developmental.” It’s helpful to have an ICD-10 code from your physician or a speech therapist familiar with your child’s case when speaking with an insurance representative. (We may be able to assist you with identifying a likely ICD-10 code.) Knowing the possible treatment/session codes (also called CPT codes) that will be used to file your child’s claims will also glean more accurate information regarding your insurance benefits. If your child’s diagnosis or treatment code is not covered by your carrier, you are considered “self-pay” and will be expected to pay the full amount for each visit regardless of where you receive services.
Whether a provider is “in-network” for your insurance carrier: If a provider is not in-network, your insurance coverage will be less even if the diagnosis and session code is allowed by the insurance carrier. This can range from a lower reimbursement rate to no coverage at all.
Start date for your policy year: Most, but not all, policies renew on January 1 of each year. It’s important to know this in conjunction with your deductible.
Your annual deductible and how much of it has been used: If your deductible has not been met, your insurance company will not pay the contracted amount allowed for speech therapy, and you will be responsible for all payments until your deductible is met.
How many visits your carrier allows each policy year: The number of visits allowed varies greatly. Some carriers cover as few as ten sessions per year while others cover sixty or more. Some do not cover any speech and language therapy office visits. BE SURE TO FIND OUT IF PRE-AUTHORIZATION IS REQUIRED AND WHAT THE PROCEDURE IS FOR OBTAINING IT. WRSLP will not apply for authorization of services past the end date of our participation in insurance networks (see above).
Amount of your co-pay: Your insurance plan may have no co-pay, while others pay a percentage of each session fee or a flat amount per session. Do not assume that if your friend has Medical Mutual and you have Medical Mutual that your plans are the same. Each insurance carrier administers hundreds of individual plans with greatly varying benefits.
