It is critical that you be familiar with your insurance coverage for speech therapy. In order to provide uninterrupted treatment, it is necessary to be aware of what insurance requirements apply to your plan.
It is strongly recommended that you, the parent or guardian, contact your insurance company to see what therapy benefits apply to your plan. If a physician’s referral for speech therapy is required by your insurance plan, you are responsible to request and provide the referral. Insurance plans often require pre-authorization for speech therapy, and occasionally there is a limit on the number of visits allowed or an annual monetary cap. Coastal Speech Therapy, Inc. will make every effort to keep you informed of the status of your insurance benefits. However, the final responsibility rests with you, the parent or guardian.
I understand that I am financially responsible for payment to Coastal Speech Therapy, Inc. Speech Therapy for all charges not covered by my insurance company. I authorize medical benefits to be paid directly to Coastal Speech Therapy, Inc. I also authorize Coastal Speech Therapy, Inc. or the insurance company to release any information required for this claim. I understand that any unpaid balance over 60 days is subject to being turned over to a collections agency and/or a 1.5% monthly finance charge on the unpaid balance. I also authorize Coastal Speech Therapy, Inc. Speech Therapy to release any information to my insurance company that is required for processing of this claim. I hereby authorize speech therapy as prescribed by my physician.
New Patient Forms:All forms, except those indicated as “optional,” are required for new patients.