Patient Registration

PTP is an in-network provider for the follow insurances:

• Anthem Blue Cross/Blue Shield
• Cigna Healthcare
• OSU Caresource

PTP will send a claim for the following insurances:

• United Healthcare
• Aetna

Other funding sources that you can use at PTP:

• Delaware County Board of Developmental Disabilities
• Autism Scholarship
• Jon Peterson Scholarship
• PASS Funding
• POLR Funding

Know What Your Insurance Covers

Many insurance plans cover Occupational Therapy and Speech and Language Therapy services, however there may be certain terms and conditions that apply.

It is important to know what your plan will cover before you access our services.

Call your insurance company to find out what services your plan covers. You will find a helpful worksheet in our Patient Registration forms list.

Here are some questions you should ask:

• Does my plan provide coverage for the type of services offered at PTP?
• Does my plan require that the service be “medically necessary”?
• Are evaluations covered?
• Does my plan require pre-authorization?
• How many therapy sessions are allowed under my insurance plan?
• What is my deductible amount?
• What out-of-network coverage do I have if I go to a facility/provider that does not accept my insurance?

INSURANCE FAQs:

Do we need a referral from our physician to come to PTP for speech or occupational therapy services?
We do not require you to have a medical doctor refer you for services, but if you want services reimbursed by an insurance company, it is often necessary that you get one. Most clients find it helpful to have a medical referral on record so it is there if needed.

Insurance companies differ regarding the need to obtain pre-authorization for services. PTP has a worksheet with questions to ask your insurance company so that you know you are getting the best information.

PTP will obtain the prior authorization for treatment for occupational and speech therapy clients that are utilizing insurance plans that we are participating in-network.

What is a Letter of Medical Necessity and when do I need one?
A Letter of Medical Necessity (LMN) is a letter from a primary care physician providing Pediatric Therapy Partners with a diagnosis for referring a client for service.

What is the difference between a referral and a Letter of Medical Necessity?
A referral is usually an approval number with number of visits provided by the primary care physician for HMO members. A Letter of Medical Necessity is a doctor’s letter with a diagnosis or reason for referring a client to a specialist.

When do I need to pay if you are also billing my insurance?
If PTP is a participating (in network) provider of your insurance company you are required to pay your co-payment at the time of service.

Can my insurance company pay you directly and I only pay the copayment/coinsurance?

PTP can only do this for insurance companies for whom we are an in-network provider.

The insurance company said that you issued an inappropriate code for the occupational therapy evaluation.

PTP uses the code that best fits the service provided. It is imperative that the appropriate code be used when billing for services.