PAULA KORIK & ASSOCIATES

SPEECH LANGUAGE THERAPY

Insurance Information And Policies


We provide speech therapy services as participating providers for a number of health insurance companies (see list below).  As participating providers, we are not an employee of any insurance company.  The insurance company has chosen us to provide quality services to meet their need to provide speech therapy services under specific benefit plans. We are an in-network provider for the following companies:


Amerihealth

Blue Cross Blue Shield (NJ/NY)

United

Cigna

Magnacare (NY)


Note: Insurance plan acceptance information is subject to change without notice.


If your insurance company is not listed above, you may submit for out-of-network speech therapy reimbursement.  You will be provided with an invoice to submit to your insurance company.  It will contain the necessary information including: diagnosis and treatment codes, session times, fees paid, description of services provided, as well as pertinent practice information (tax id, license number, etc). We will also provide you with assessment and therapy progress reports to submit to your insurance company along with the invoice.


Agreements for Insurance Billing:


It is your responsibility to determine if a prescription is required by your insurance company.  A prescription for services from your primary care physician may be required in order to bill any insurance company.  You are responsible for obtaining this prescription prior to the initial visit.  If for any reason we are unable to verify insurance eligibility prior to the office visit, you are responsible for full payment upon services being rendered.


Verification of benefits is not a guarantee of payment. You are responsible for the initial authorization required by your insurance and any charges not covered by your insurance. Our financial contract is with you, not your insurance company.  We bill your insurance our current fees and accept their allowable amounts as payment only if we are their in-network provider (see the list above). We do require payment for services rendered at the time of service. This means that any copays or co-insurance that you are responsible for will be collected at the time of your visit.  If you have an annual deductible that has not been met yet, this too will be collected at the time of service.


State Insurance Mandates for Autism Spectrum Disorder:


New Jersey

Requires specified health insurance policies and health benefit plans to provide benefits for treatment of autism or other developmental disability. Coverage shall include: medically necessary occupational therapy, physical therapy, and speech therapy, as prescribed through a treatment plan. The maximum benefit amount for a covered person in any calendar year through 2012 shall be $37,080.


Citation: N.J. Rev. Stat. §17:48-6ii; §17:48A-7ff; 17B:26-2.1cc; 17B:27-46.1ii; 17B:27A-7.16; 17B:27A-19.20; §26-2J-4.34; §52:14-17.29p; 52:14-17.46.6b


New York

Requires every policy which provides physician services, medical, major medical or similar comprehensive-type coverage to provide coverage for the screening, diagnosis and treatment of autism spectrum disorder. Coverage includes, therapeutic care, which is habilitative or nonrestorative, provided by a licensed or certified speech therapist.


Citation: N.Y. ISC. Law §3216