Getting Started
1.
Inquire and Complete Intake Paperwork
2.
Intake, Assessment, and Treatment Plan
3.
Begin Therapy
4.
Parent Training
5.
Assessment and Alterations
Parent/Patient Responsibility
It is a patient and families responsibility to know and understand their insurance policy.
For example, you are responsible for any charges if any of the following apply:
• Your health plan requires prior authorization or referral for a physician before
receiving services and you have not obtained such authorization or referral
• You receive services in excess of such authorization or referral
• If your health plan has a deductible, copay, coinsurance, etc. that applies to
services (see below)
• Your health plan determines that the services are received at not medical
necessary and/or not covered by your insurance plan
• Your health plan coverage has lapsed or expired at the time you receive services
• You have chosen not to use your health care coverage
• *If you are not familiar with your plan coverage, we encourage your to contact
your plan directly.
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Insurances We Accept
Frequently Asked Questions
What is a copay?
A copay is a set rate you pay for prescriptions, doctors visits, and other types of care. A copay does not apply to your deductible. Copays typically occur until you meet your out of pocket maximum (see below). Not all plans have a copay.
What is an out of pocket maximum?
Out of pocket maximum is the most you'll have to pay during a benefit period, typically one year, for health care your plan covers. Once an out of pocket maximum is met, the plan will pay 100% of the allowed amounts for covered services.
What is a script/referral?
A script is a medical referral that a physician writes in order to deem that a service is medically necessary. Insurance providers require a script on file prior to beginning services.
What is a diagnosis code?
A diagnosis code is a medical diagnosis a physician makes and writes on a script to deem a service medically necessary.
What is the difference between in-network and out-of-network?
Clinics must be credentialed with an insurance company to be considered in network or a participating provider.
If a clinic is not credentialed with a particular health insurance plan they are considered out of network.
The biggest difference between the two is usually cost for the patient. In network providers agree with insurance plans to accept approved amounts for services, which is typically a cost savings for members. Insurance companies usually pay higher rates for out-of-network providers which may translate to higher costs for the patient.
What is a deductible?
A deductible is the amount you pay for covered health services before your plan begins to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment.
What is coinsurance?
Coinsurance is the percentage of costs you pay after your deductible has been met and before your of pocket is met.
What is a covered vs non-covered benefit?
A covered benefit is a service that your plan includes coverage for but is likely to be subject to deductible, coinsurance, copays, etc.
A non-covered benefit is a services that your plan does NOT include coverage for and the customer is responsible to pay 100% of the service to the provider.
What is a CPT code?
A CPT code is a uniform language for coding medical services and procedures. These codes are used to describe medical procedures performed by medical facilities. These codes can be provided to families in order to cover services.
What are the required documents to complete enrollment and begin scheduling?
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Front/back of insurance card
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Driver’s license of policy holder
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Up to date script for service enrolling in
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Completion of Enrollment Form – this should be sent directly to Enrollment@bluestonechildrenscenter.com
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Most recent evaluation report(s)
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Patient demographics in patient portal
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Enrollment Coordination Fax Number: 947.200.0869
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Enrollment Coordinator Phone Number: 248.807.0688