Which insurance companies are Northshore Pediatric Therapy providers currently in-network with?

Premera, Regence, and First Choice Health Network.

What if I have health insurance with a different company?

We are considered an out-of-network provider by insurance companies not listed above. This means that many clients who have health insurance may be eligible for reimbursement for a significant portion of our fee.

How do I determine my insurance coverage for speech or occupational therapy?

We can provide general information about insurance coverage, but you are ultimately responsible for contacting your insurance company and determining benefits for the services you receive, or would like to receive, through Northshore.

It is important to note that information collected from insurance companies is a quote, and not a guarantee of payment.

Benefits, if any, will be assessed by your insurance plan. Once insurance companies receive claims for specific services, these claims are subject to eligibility and based on plan provisions and limitations in effect at the time that the service was rendered (when the service occurred).

Any and all charges/balances that are not covered by a client’s insurance company are the responsibility of the client.

Are any of Northshore’s services not covered by insurance?

Yes. services not covered by insurance include:

Consultations

IEP and school meetings

Travel to meetings or therapy sessions in community settings

Missed appointments without advance notice (see our attendance/cancellation policy for details)

What if my insurance is out of network?

It is the client’s responsibility to contact their insurance company to find out whether or not they will be reimbursed for Northshore’s services. We recommend determining this information before starting therapy services at Northshore to avoid any surprises.

I am on the phone with my insurance company. What do I say?!

Here are some questions to ask your insurance company:

Do I have speech language pathology and/or occupational therapy insurance benefits?

• Do my benefits cover developmental speech language pathology services?

  • Common CPT Codes (healthcare service/procedure codes) related to speech therapy:

    92507 - Speech therapy treatment session

    92523 - Evaluation of speech/language/social communication

• Do my benefits cover developmental occupational therapy services?

  • Common CPT Codes related to OT:

    97530 - Therapeutic activities, direct 1:1 (15 min chunks)

    97165, 97166, 97167 - OT Evaluation (low, moderate, or high complexity)

• How much does my plan reimburse for an out-of-network provider? (What percentage of the fee will I be reimbursed?)

• Is approval required from my primary care physician? Is pre-authorization required?

• What is my deductible and has it been met?

• How many sessions per year does my health insurance cover?

• What is the coverage amount per therapy session?

• Are there any other restrictions I should know about, or any other questions I should be asking?

What else should I know about payment for Northshore’s services?

In-Network:

If you have Regence, Premera, or First Choice Health Network, your insurance company will be billed for our services first. Any balance after insurance processes a claim, such as copayment, coinsurance, or deductible, is invoiced directly to the client to be paid through their chosen payment method (credit/debit, check, cash, etc.).

Out of Network or Private Pay:

Payment is due, in full, at the time of service. A superbill will be provided upon the client’s request.

We accept cash, check, debit, and all major credit cards for payment.

Contact us if you have any other questions about insurance and billing.