This is part 2 of our blog series all about getting started with CI!


The journey into insurance isn’t one you have to walk alone! ---


So you have found a top-notch therapy provider, and you’re so excited for your child to start! But before they do, you have to journey through the world of insurance (cue suspenseful music). Navigating coverage with your private insurance carrier may seem like a never-ending line of hoops to jump through.

But have no fear, the CI Billing Team is here! Not only are we fluent in insurance jargon, but we are also passionate about helping families maximize their coverage.

CI is a trusted and contracted provider for most local insurance carriers. We are proud of outstanding and valued relationships with the following insurance companies:

  • Aenta
  • The Alliance
  • Auxiant
  • ChampVA
  • GHC (ASD Diagnosis)
  • Dean (ASD Diagnosis)
  • Health EOS
  • Humana
  • Physicians Plus
  • Quartz (Unity)
  • Tricare
  • United Health Care
  • UMR
  • WPS

Our Billing Team is committed to helping our new and current families navigate the insurance process, so it can be as smooth and simple as possible.

Once intake paperwork is completed, we begin by helping you contact your insurance to investigate your policy's coverage and benefits. Then, we will submit any necessary insurance authorizations at your request. We do this before any appointments are scheduled to ensure you do not accrue charges unknowingly.

At this point, a few things can happen: your insurance can approve the authorization request, your insurance can deny the authorization request, or your insurance is out-of-network with CI.

If your insurance approves the authorization request, we can begin scheduling appointments. You will receive a copy of the authorization in the mail, and we will continue to submit any authorizations required in the future. While the insurance company has approved the requested services at CI, your policy specifics still apply (such as coinsurance, copays and deductible).

At times your insurance may deny our request for an authorization. If that is the case, one of our Billing Team Members will give you a call and explain the reasoning for the denial. You always have the option to appeal the denial, and we can help you with the appeal process.

If your insurance carrier is out-of-network with CI, we will still contact them to verify any benefits you may have for out-of-network providers. In some cases, insurance companies will approve your claims to be processed as in-network. If we are not able to obtain coverage through your insurance carrier (due to a denial or out-of-network status), we can discuss payment options, such as our out-of-pocket discount.

Now for the fun stuff! We don’t want to keep all of the cool insurance lingo to ourselves. So here are some terms that you will likely come across:

      
  • Benefit Year– The annual time frame that your insurance runs (note: this is not always the calendar year). The Benefit Year rolls over on the same day every year and is not the same for all insurance policies

  • Exclusion– A service or diagnosis that your insurance company will not cover
  •   
  • Deductible – An amount that you have to pay before insurance will pay any amount for your claims

  • Co-Pay – A dollar amount that is the same for each visit

  • Co-Insurance – A percent of the visit that you are responsible for

  • Maximum Out of Pocket – A total amount that you are responsible for, this is for a benefit year and usually includes deductible, copays and coinsurance. It does not include any exclusion listed in your policy

  • Rehabilitative – To improve a skill or ability that was lost due to a illness or disease.

  • Habilitative – To improve a skill or ability that you have not had in the past. This would include when a child is not walking or talking as soon as expected.

  • Authorization - This is approval from your insurance company that they will cover the services requested; coinsurance, copays and deductible will still be the patient liability.

For all your insurance questions, don’t hesitate to give our Billing Team a call at (608) 497-3198!


For part 1 of this blog series, click here!