(925) 743-3322
INSURANCE & PAYMENT INFORMATION
Billing and Payment Policy

 Language Essentials
Billing and Payment Policy

Language Essentials will collect all fees due at the time of the service. This includes but is not limited to private pay clients, insurance co-pays, co-insurance and deductibles. 

 If the Client is a member of an insurance company of which Language Essentials is an in-network provider, Language Essentials will submit payment claims on behalf of the Client to the insurer. As a courtesy Language Essentials will submit claims to the insurance company, a maximum of two times. Any further insurance appeals are the responsibility of the Client. This includes, but is not limited to, insurance company denial of coverage for any procedure and/or diagnostic code, policy deductibles, policy maximums for annual or lifetime benefits being exceeded, insurance paying an amount for a procedure based on its usual and customary benefit schedule which is less than the fees charged by Language Essentials for such procedure and Language Essentials not receiving payment within 45 days even if you are appealing the denial of insurance benefits by the carrier. Language Essentials is not responsible for tracking the number of allowable visits/sessions per coverage period. This is solely the responsibility of the Client.  

If the Client is the member of an HMO, a referral is required prior to services being rendered by Language Essentials. If we do not have a referral at the time of the patient’s initial appointment, the appointment will be rescheduled, or, by signing this document, the Client accepts responsibility for all charges incurred until a referral and payment are received by Language Essentials.  

Language Essentials is not responsible for tracking the expiration dates of insurance coverage authorizations. It is solely the responsibility of the Client to monitor coverage authorizations, inform Language Essentials of pending expiration dates, and to request new authorizations from their insurance carrier.

Language Essentials will be paid in full by the Client regardless of the status of the Client’s reimbursement with his/her insurance company. Language Essentials has no responsibility for non-reimbursement by the Client’s insurance company.

Language Essentials reserves the right to refuse services if payments are not received within 10 days of the previous month’s invoice or the equivalent of three therapy sessions. The Client acknowledges Language Essential’s right to add interest, late fees ($25.00 per month) and collection costs (including legal fees), if applicable, to any invoice not paid within this period. If payments by the Client are returned for any reason, Language Essentials will add the returned check fee, denied credit card fee or any other related fees to the amount owed by the Client.

In the event of illness or other scheduling conflict, the Client will contact Language Essentials 24 hours in advance if possible. We will make every effort to reschedule any missed appointments, which may include your child / you seeing another therapist. Language Essentials believes that consistency in therapy is the most important component to meeting goals. Appointments missed without cancellation notice, or late cancellation notice will be billed to the Client at the missed session rate of $50.00. It is within Language Essentials’ discretion to cease scheduling the Client for future appointments if there are repeated cancellations, no-shows or refusal to make up missed sessions.
ASHA,  American Speech and Hearing Association, Speech Pathology, Speech Therapy, swallowing, tongue thrust, oral-facial, accent reduction, reading intervention
ASHA,  American Speech and Hearing Association, Speech Pathology, Speech Therapy, swallowing, tongue thrust, oral-facial, accent reduction, reading intervention
ASHA,  American Speech and Hearing Association, Speech Pathology, Speech Therapy, swallowing, tongue thrust, oral-facial, accent reduction, reading intervention
ASHA,  American Speech and Hearing Association, Speech Pathology, Speech Therapy, swallowing, tongue thrust, oral-facial, accent reduction, reading intervention
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Insurance Terms/Definitions

The following are terms utilized by the medical insurance industry concerning your payment responsibility. These are general definitions.  Your insurance company may have different ones:

Coinsurance - A form of medical cost sharing in a health insurance plan that requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, was paid.
   ♦ Once any deductible amount and coinsurance are paid, the insurer is responsible for the rest of the reimbursement for covered benefits up to allowed charges: the individual could also be responsible for any charges in excess of what the insurer determines to be “usual, customary and reasonable”.
   ♦ Coinsurance rates may differ if services are received from an approved provider (i.e., a provider with whom the insurer has a contract or an agreement specifying payment levels and other contract requirements) or if received by providers not on the approved list.
   ♦ In addition to overall coinsurance rates, rates may also differ for different types of services.

Copayment - A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement.
   ♦ There may be separate copayments for different services.
   ♦ Some plans require that a deductible first be met for some specific services before a copayment applies.

Deductible - A fixed dollar amount during the benefit period - usually a year - that an insured person pays before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.
   ♦ Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.
   ♦ Deductibles may differ if services are received from an approved provider or if received from providers not on the approved list.

Maximum plan dollar limit - The maximum amount payable by the insurer for covered expenses for the insured and each covered dependent while covered under the health plan.
   ♦ Plans can have a yearly and/or a lifetime maximum dollar limit.

Maximum out-of-pocket expense - The maximum dollar amount a group member is required to pay out of pocket during a year. Until this maximum is met, the plan and group member shares in the cost of covered expenses. After the maximum is reached, the insurance carrier pays all covered expenses, often up to a lifetime maximum.