INSURANCE

IN NETWORK BILLING

• The Boston Ability Center is currently an in-network provider with Blue Cross Blue Shield of MA and Allways Health Care. The patient’s insurance card is required prior to the first visit, and a photocopy of the card will be kept on record. All co-payments and past due balances are due and payable at the time of service.
• Once a patient’s insurance benefit is exhausted, either by way of time elapsed or visit count, the patient is responsible for payment for treatment in full at the time of service.  See self-pay information below.
• If you have filed or plan to file an appeal with your insurance company for denial of services for any reason, you are responsible for payment in full within 30 days of the time of service for the duration of the appeal process. Upon resolution of the appeal, if the claim is paid by the insurance company and a check is received by The Boston Ability Center, the credit balance will be refunded.

NON-PARTICIPATING INSURANCE PLANS WITH AN OUT OF NETWORK BENEFIT

If you do not have BCBS or Allways but do have a plan with an out of network benefit (for example, a PPO), The BAC will bill that plan directly on your behalf, after and only after you have called your insurance company to verify the coverage. All out of network claims that are denied after the initial submission by BAC are due, paid directly to the BAC, within 30 days of the denial notice. Should you seek to challenge the denial, The BAC will provide you with the necessary documentation but cannot be involved in the process beyond the initial submission.

NON-PARTICIPATING INSURANCE PLANS WITHOUT AN OUT OF NETWORK BENEFIT

Payment is due in full at the time of service. The Boston Ability Center will provide the patient with all necessary documentation to submit insurance claims to non-participating plans. All reimbursement checks should be sent directly to the patient and if a check is received by The Boston Ability Center, it will be forwarded to the patient.

REFERRALS - For all of the above insurance scenarios, if you are required to have an authorization in place prior to receiving care from a specialist, please contact your primary care doctor prior to your appointment. This is the patient/family responsibility.

DUAL INSURANCES - If both parents have insurance coverage, the primary insurance is determined by “The Birthday Rule”. The dependent children are covered first by the health plan of the parent whose birthday falls earlier in the year.  The other parent holds the secondary coverage. The patient (parent) is responsible for keeping BAC Billing department up to date on all insurance plan information that may impact the billing process for services received at the BAC.

VISIT COUNTS – if your coverage has a limit on visits per discipline in a year, you are responsible for keeping track of the number of visits your child has received. If you exceed the visit limit, all services after the limit has been reached are billed as self-pay. If your child was previously or is currently receiving OT, PT or speech/language therapy elsewhere, please let us know and please include those visits towards your visit count.

SAME DAY TREATMENT – Some insurance companies limit what is paid toward rehabilitation therapy and will not pay for PT and OT treatments performed on the same day.  If both services are performed on the same day, you will be responsible for payment of the uncovered service.

CHILD CUSTODY CASES - The parent with primary custody is usually the parent with whom the child lives and who usually brings the child to The Boston Ability Center for care.  The custodial parent is responsible for co-payments at the time of service for participating insurances and for all past due balances.  If the non-custodial parent carries the insurance, The Boston Ability Center will bill that insurance company.  The Boston Ability Center will not get involved with divorce settlements i.e.; one parent pays 80% and the other parent pays 20%.  It is the parents’ obligation to work out an agreement and insure prompt payment to Boston Ability Center.

SELF PAY ACCOUNTS

The parents shall pay in full at the time of service. The Boston Ability Center maintains the right to deny services to self-pay accounts that are past due. The out of pocket rate for a 45-minute physical therapy, occupational therapy or speech therapy session is $150.00. This is a reduced rate (as of May, 2020) due to the global pandemic.

Self-pay accounts include:

• Patients covered by insurance plans with which The Boston Ability Center does not participate,
• Patients without an insurance card on file
• Patients who have exhausted their insurance benefit (maximum number of covered visits has been used)
• Patients receiving non-covered treatments: Not all treatments are considered to be medically necessary and therefore will not be paid by some insurance companies.  We will do our best to inform you ahead of time for any treatments which have in the past been denied for this reason.   You will be responsible for payment should treatment be denied for this reason.

PATIENT REFUNDS - The following criteria must be met prior to issuing a patient refund; there are no outstanding insurance claims on the family’s account, and there are no outstanding patient balances on the family’s account.

PAYMENT PLAN AGREEMENTS – The Boston Ability Center is willing to extend payment plan agreements to patients with special financial needs.  Each agreement is unique to each family’s situation. Please contact Janet Wade, Boston Ability Center Director, to request special arrangements.

Same Day Treatment – Some insurance companies limit what is paid toward rehabilitation therapy and will not pay for PT and OT treatments performed on the same day.  If both services are performed on the same day, you will be responsible for payment of the uncovered service.

The Boston Ability Center requires every account to have a valid credit card on file in our secure system.

If you have questions about the BAC’s financial policies, please feel free to speak to us. By signing below, I acknowledge that I understand and agree to the BAC’s financial policies