There are 3 ways to pay for your child's therapy:

1. Prompt pay: Pay for therapy in full at the time of service. POTS will provide you with a receipt.

2. Use your out-of-network benefits. POTS directly submit charges to your insurance provider for payment. You will also be responsible for deductibles, co-pays, and co-insurance.

3. Your local Board of Education can contract with POTS (highly individualized). POTS will bill the BOE directly.

Please take advantage of our INSURANCE BENEFIT RESOURCE GUIDE (https://www.potsot.com/insurance) to help you understand the insurance process and verify your own benefits.

The 2 step process to verify your benefits:

• STEP 1 VERIFY YOUR OWN BENEFITS FIRST: You are responsible for calling your insurance company to verify that you have out-of-network benefits and get a clear understanding of your plan. Feel free to use our Insurance Resource Guide and our Insurance Verification Guide to help you verify your benefits (www.potsot.com/insurance). You are advised to record the name of the representative, the answers to your questions, and the reference # for the call. If you ever need to revisit this information the reference # will help the insurance company representative to locate it.

• STEP 2: Call POTS and let us know that Step 1 is completed; POTS will now verify your benefits as well. Please send a copy of the front and back of your insurance card along with your child's name and date of birth, as well as the insurance subscribers’ name and date of birth to mary@potsot.com, or you can upload your card at the end of this form.

• We will provide a Benefit Quote Form outlining your insurance benefits as of the date of issue, with the understanding that the nuances of insurance reimbursement are not under POTS' control. We will schedule your evaluation or sessions once your benefits are determined.

• For any questions about arranging finances please email Kellie Naumov: kellie@potsot.com.

 

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I understand that ultimately, all parents have financial responsibility for the services they sign up to receive for their child. If it is determined that my insurance covers POTS therapy services, POTS will bill my out-of-network health insurance company as a courtesy. While POTS will attempt to work with my insurance company to help resolve any issues that may arise, I understand that I am ultimately responsible for the payment of therapeutic services rendered by POTS.

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Not all services provided by POTS are covered benefits under all insurance plans. If my claim is denied by my insurance carrier for any reason, I understand that I am responsible for paying POTS 100% of the balance due for all therapeutic services rendered.  

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I understand that if insurance does not pay my claim to POTS within 90 days from the date of service for any reason, my credit card will be automatically charged in full for the expected payment from the insurance. Should insurance pay at a later date, the funds will be credited to my POTS account.

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I understand that for the first 3-5 sessions, or until I receive an EOB, I will be billed the full co-pay or co-insurance amount. If I have overpaid, those funds will be credited towards future co-pays. POTS will issue a credit if there are any remaining funds when my child’s course of treatment is completed.

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POTS will resubmit correctly coded claims twice. After that time it is my responsibility to pursue the insurance company. If you would like our biller's assistance after that time, we will bill your credit card $75.00/hour for her services.

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I understand that if I am insured by Horizon BC/BS or other carriers which issue POTS' payments to me, all checks issued to me for services rendered at POTS will be delivered to the POTS office no later than two weeks after the issue date on the check. If the checks are not delivered to POTS on time, I understand that POTS will charge my credit card on file for the same amount of the checks, and I will keep the checks.  

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I understand that it is my responsibility to update POTS with my insurance information each time it changes. If I have provided incorrect insurance information and it precludes POTS from obtaining payment for services, I understand that 100% of the charges associated with my child’s treatment will be my responsibility.

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I understand that evaluations must be paid in full on the day of the evaluation regardless of insurance status.

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I understand that all payments are due at the time of service. If POTS is billing my insurance company directly, I understand that POTS is obligated to collect any co-pay, co-insurance, or remaining deductible, and I must pay my co-payment, co-insurance, or remaining deductible in full at the time of service.

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I understand that I will receive an invoice via email after every session. Please open your invoice immediately upon receipt and download it to your device; the online version will expire in 7 days due to HIPAA regulations. There is a $5.00 fee for re-sending each invoice.

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I understand that the parent or guardian accompanying my child to his/her treatment session is responsible for payment at the time of service, or POTS will bill the credit card on file. In the case of a marital separation, divorce proceeding, or completed divorce, I will not put POTS in the middle of marital disputes as a divorce decree is a legal document binding only the two parties to it. It is my responsibility to work out payment of my child’s services between the custodial and non-custodial parent.

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I understand that POTS requires that a current credit card (not debit card) be kept on file to guarantee payment of services, and for your child to receive treatment. This information will be stored securely. If you are using an HSA or FSA card, sufficient funds must be available for services rendered. I will further review this policy on the Credit Card Consent Form that I sign when I put my credit card information on file.

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There is an additional $25.00 fee each time the credit card is declined for insufficient funds

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Should a cancellation take place within 48 hours of a scheduled appointment, I will be responsible for a $25 cancelation fee. If I cancel within 24 hours of a scheduled appointment, I will be responsible for a Late Cancellation Fee of $80.00. If I do not show up for my appointment I will be billed a No-Show Fee equal to the current rate for my session.

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All accounts are expected to remain current. If your account is 30 days past due you will be subject to a recurring late fee of 5% of the outstanding balance for every 30 days it is past due. In addition, your child's therapy will be on hold until your account is paid in full. You may be required to put down a deposit for future sessions. 

If we cannot reach a parent or guardian following the return of undeliverable mail or email, we will be forced to use the services of a professional collection agency. Please let us know when or if your contact information has changed so that we can always reach you.

I understand that once an account is placed with a collection agency, POTS cannot take the account back and I will resolve the past due account directly with the collection agency. Your child cannot come to therapy until the account is current.

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Failure to provide updated insurance information to POTS may result in denials and delays that POTS is not responsible for. Payment in full for all services is always the parent's responsibility.

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