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Billing, Payment and Attendance  Policies

 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. This requires your current insurance information and a copy of your insurance card. We also require your social security number for our records. Your financial records as well as your medical records are kept confidential and secure. 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.  

It is the Client’s responsibility to know their speech therapy benefits, limits and exclusions, in addition to their deductibles and copay or coinsurance amounts. 

It is your responsibility to make sure the insurance plan we have on file is the most current. Any claim that needs to be resubmitted due to new insurance, incomplete or outdated information will incur a $25 administrative refiling fee.

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 ($35.00), denied credit card fee or any other related fees to the amount owed by the Client.

ASHA,  American Speech and Hearing Association, Speech Pathology, Speech Therapy, swallowing, tongue thrust, oral-facial, accent reduction, reading intervention
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. 

 Language Essentials
Attendance Policy

Please be advised of the following office information. While this policy may seem rather rigid it protects your child’s privacy, maintains a quiet and safe therapy session, helps to shield your child and the therapist from infectious diseases and keeps the schedule flowing smoothly. This consistency assists greatly in facilitating optimum levels of progress. Failure to comply with this policy may result in a loss of your weekly session which will be communicated to you in writing.

Illness: In the event of illness, the Client will contact Language Essentials 24 hours in advance if possible. Language Essentials understands that there may be an occasion when there is an emergency, and these situations will be decided on a case by case basis so as to not allow for abuse of the policy.
oPlease cancel if your child has:

Fever of 100 degrees or higher
Diarrhea / vomiting
Uncontrollable cough
Conjunctivitis (Pink eye)
Contagious Rashes

Client must be fever free for 24 hours prior to scheduled session

Please Initial Each of the Following:

Schedule Conflict: In the event of any other scheduling conflict (i.e. vacations, school events, etc.), the client will contact Language Essentials at least72 hours in advance. We expect a commitment to the process of speech-language therapy. Therefore, please consider scheduling other appointments around your or your child’s therapy time to keep a consistent schedule.

Makeup slots: We offer makeup sessions, as it is in the client’s best interest. Makeup slots are offered for illness, holidays and pre-arranged vacations. Makeup slots may include the client seeing another therapist, as Language Essentials believes that consistency in therapy is the most important component to meeting goals. Makeup sessions are not offered when there is a violation of the cancellation policy. For example, if you are charged for a no show, we will not reschedule that visit. Makeups must be attempted for all holidays, vacations and cancellations for both the client and the therapist. Each client attending weekly sessions, and the therapist, is entitled to 2 weeks vacation a year without makeups. All other sessions will be recorded in the Client’s file, and if makeups are not completed this is considered a violation of  the policy.

Tardiness: If clients are late, they only receive therapy for the time slot they have been assigned. For example, if a client arrives at 3:45pm for a 3:30pm appointment, we will still end at 4:15. Please be on time for your session to assist in maximum progress.

Charges for No Shows: Appointments missed without the required cancellation notice or late notice will be billed to the Client at the following rates:
o1st time: $75.00
o2nd time $100.00
o3rd time $125.00 and you will be discharged from services.
This fee must be paid before the next scheduled session. Refusal to pay the fee will lead to discharge.

If the Client exceeds a cancellation rate of 20% or greater in a three month period, you will receive a written warning that your scheduled timeslot is in jeopardy, this is particularly true if you do not schedule and attend make up sessions, which may be with another available therapist.

Extended Vacations: Language Essentials allows 2 weeks consecutively for vacations, in the event your family will be out longer than the allowed time you/your child will removed from the schedule and placed on the waitlist when you return. If you choose to hold your weekly scheduled time, you may provide payments equivalent to regularly scheduled sessions for each missed session with a credit card on file.

Vacations and Holidays: Language Essentials does not maintain the same schedule as a public or private school, so please do not assume that because your child’s school is closed, that your child does not have speech therapy. If in doubt, please call the office to verify. Makeups and alternative scheduling are available for most holidays and vacations. Any client taking a vacation for more than 2 consecutive weeks will forfeit their scheduled timeslot. In addition, if you observe religious holidays, it is expected that sessions be made up, with scheduling planned 2-3 weeks in advance. Failure to notify the office of a vacation will result in strict enforcement of the cancellation policy. We will close for most major holidays, but not all federal holidays (ex. Columbus Day.) If you are in doubt, please ask at the front desk. Notices are posted at the front desk as well.

Discontinuation of Services: If you plan on discontinuing services for any reason, you must give this office a minimum of 4 weeks’ notice or you will be billed for the missed sessions. A discharge report will be prepared free of charge if you have been up to date with payments, and give this office the required notice.