Abilitations Children's Therapy will verify your benefits prior to your first appointment. This is courtesy and is your estimated coverage information. While we try to obtain the most accurate information, it is ESTIMATED, and does not release you from your responsiblity of your account balance.
We are IN NETWORK with the following insurance plans:
Aetna (except Duke Select, Duke Basic)
Blue Cross Blue Shield (except Blue Value plan and Blue Home plans)
Cigna
Humana
Medcost
Medicaid Direct
All MCP's: Healthy Blue, United Healthcare Community, Carolina Complete Healthcare, Amerihealth Caritas, Wellcare
Humana Tricare (we will no longer be accepting Humana Tricare insurance as of July 1, 2023)
United Health Care
UMR/Multiplan (Tier 2 provider for UNC Healthcare plans)
Early Intervention Providers for Wake County
Understanding your insurance plan benefits can be confusing. Here are some frequently used terms you may hear:
Deductible: Is the amount you pay for health care services before your health insurance begins to pay. For example, if your deductible is $1,500, you would pay 100 percent of your health care charges until the amount you paid reaches $1,500. After that, some services you receive may be covered at 100 percent, or you may have to pay coinsurance.
Coinsurance: Is your share of the costs of a health care service. It's usually figured as a percentage of the total charge for the service. You start paying coinsurance after you've paid your plan's deductible. For example, say you’ve already paid out (or met) your $1,500 deductible and your coinsurance is 20 percent. For a $100 health care bill, you would pay $20 and your insurance company would pay $80.
Copay: Is a fixed amount you pay for a health care service, usually when you receive the service. We are a specialist office, so your plan might differentiate copay amounts to your Primary Care Physician and a Specialist. This amount usually does not change with each visit, however certain plans require an additional coinsurance on evaluations/re-evaluations. For example, if you have a $20 co-pay for specialist office visits, you would pay $20 to our office each visit.
Visit Limits: Some plans specify a limit on the number of physical/occupational/speech therapy visits allowed per plan year. Sometimes these visits are combined with other services such as chiropractic care or occupational therapy. Other times, the visit limit applies to each service only. It is each patient's responsibility to keep up with the number of visits they have used. Once you have exhausted your visit limit, your insurance will often not pay for additional visits. If your therapist determines that more visits are necessary, we offer private fee rates for each discipline. We are happy to assist you in planning ahead in these situations, so that we can come up with an effective plan for your child's optimal recovery.
We cannot guarantee what your insurance carrier will and will not pay. As always, we look to our patients to understand their benefit packages, which are issued through their employer groups. If you have any questions concerning your insurance benefits, each insurance company has a member service department available for questions. We will send your claims for services rendered to your insurance carrier for you, and will even appeal an unreasonable denial, but there are times when we will need to request and receive your assistance in the processing of your claims. As the services are rendered to you, we do ultimately hold you financially responsible for your balance.
The following links are to assist you in understanding insurance coverage for therapy services in order to find the best plan to fit your family's needs:
Physical Therapy and your Insurance
Speech Therapy Insurance Tools from ASHA
Blue Cross Blue Shield (except Blue Value plan and Blue Home plans)
Cigna
Humana
Medcost
Medicaid Direct
All MCP's: Healthy Blue, United Healthcare Community, Carolina Complete Healthcare, Amerihealth Caritas, Wellcare
Humana Tricare (we will no longer be accepting Humana Tricare insurance as of July 1, 2023)
United Health Care
UMR/Multiplan (Tier 2 provider for UNC Healthcare plans)
Early Intervention Providers for Wake County
Understanding your insurance plan benefits can be confusing. Here are some frequently used terms you may hear:
Deductible: Is the amount you pay for health care services before your health insurance begins to pay. For example, if your deductible is $1,500, you would pay 100 percent of your health care charges until the amount you paid reaches $1,500. After that, some services you receive may be covered at 100 percent, or you may have to pay coinsurance.
Coinsurance: Is your share of the costs of a health care service. It's usually figured as a percentage of the total charge for the service. You start paying coinsurance after you've paid your plan's deductible. For example, say you’ve already paid out (or met) your $1,500 deductible and your coinsurance is 20 percent. For a $100 health care bill, you would pay $20 and your insurance company would pay $80.
Copay: Is a fixed amount you pay for a health care service, usually when you receive the service. We are a specialist office, so your plan might differentiate copay amounts to your Primary Care Physician and a Specialist. This amount usually does not change with each visit, however certain plans require an additional coinsurance on evaluations/re-evaluations. For example, if you have a $20 co-pay for specialist office visits, you would pay $20 to our office each visit.
Visit Limits: Some plans specify a limit on the number of physical/occupational/speech therapy visits allowed per plan year. Sometimes these visits are combined with other services such as chiropractic care or occupational therapy. Other times, the visit limit applies to each service only. It is each patient's responsibility to keep up with the number of visits they have used. Once you have exhausted your visit limit, your insurance will often not pay for additional visits. If your therapist determines that more visits are necessary, we offer private fee rates for each discipline. We are happy to assist you in planning ahead in these situations, so that we can come up with an effective plan for your child's optimal recovery.
We cannot guarantee what your insurance carrier will and will not pay. As always, we look to our patients to understand their benefit packages, which are issued through their employer groups. If you have any questions concerning your insurance benefits, each insurance company has a member service department available for questions. We will send your claims for services rendered to your insurance carrier for you, and will even appeal an unreasonable denial, but there are times when we will need to request and receive your assistance in the processing of your claims. As the services are rendered to you, we do ultimately hold you financially responsible for your balance.
The following links are to assist you in understanding insurance coverage for therapy services in order to find the best plan to fit your family's needs:
Physical Therapy and your Insurance
Speech Therapy Insurance Tools from ASHA
