Maximizing Your Child's Care with Kids Feeding Wellness: A Guide to Out-of-Network Services and Insurance Reimbursement
Prior to deciding to partner with Kids Feeding Wellness, we want to make sure you have a complete understanding of how we operate as an out-of-network healthcare provider, and the options available to you for reimbursement and payment. We hope that this information is useful in guiding you towards a well-informed decision.
Is insurance accepted by Kids Feeding Wellness?
As an out-of-network* healthcare provider, we do not accept direct insurance payments from insurance companies. This means if you choose to receive services from us, you will need to pay for the services out-of-pocket at the time of your visit. However, If your health insurance policy includes coverage for out-of-network services, you will receive a superbill* at the end of each month that you can submit to your insurance company to request reimbursement for the services you received.
Out-of-Network*
An out-of-network provider refers to a healthcare provider (such as a doctor, hospital, or specialist) that does not have a contract with your health insurance plan. This means that if you receive medical services from an out-of-network provider, your health insurance plan may not cover the full cost of the services or may not cover them at all.
Typically, health insurance plans negotiate discounted rates with certain healthcare providers in their network, meaning that when you visit an in-network provider, your out-of-pocket costs will be lower. However, when you visit an out-of-network provider, you may have to pay a higher share of the cost or the full cost of the service yourself.
Superbill*
A superbill is a document that itemizes the services provided to a client by a healthcare provider. It includes information such as the name and contact information of the provider, the client's personal and insurance information, the dates of service, and a detailed breakdown of the services provided, including any medical codes and charges.
Superbills are usually used by healthcare providers who do not participate in insurance networks or who have clients with out-of-network benefits. clients can use the superbill to submit a claim to their insurance company for reimbursement. It's important to note that not all insurance plans will accept superbill submissions, so clients should check with their insurance company to confirm their reimbursement policies.
Benefits of Working with an Out-of-Network Provider
As an out-of-network provider, Kids Feeding Wellness can offer several benefits to clients seeking feeding and orofacial myofunctional therapy.
Higher quality care with a personalized approach tailored to meet the unique needs of your child
Flexibility to provide the most appropriate treatment without being constrained by insurance policies
Greater flexibility and control over the services needed for your child's unique needs
Treatment plan can be adjusted and customized to best suit your child's needs and progress, rather than being limited by pre-determined guidelines or coverage limitations set by an insurance company
Ability to determine the appropriate number of sessions for your child, rather than being dictated by insurance policies or coverage limitations
More availability and shorter wait times for appointments
Assurance that your child's care is the top priority, and that the treatment plan is customized to meet their unique needs without being limited by insurance policies
Choosing Kids Feeding Wellness as an out-of-network provider can provide clients with the assurance that their child's care is the top priority, and that the treatment plan is customized to meet their child's unique needs without being limited by insurance policies.
How can I receive reimbursement from my health insurance?
Please be aware that understanding your insurance coverage and adhering to the necessary procedures to receive reimbursement is the responsibility of the client. In certain cases, insurance companies may require pre-authorization* from your primary care physician before approving certain services. If your insurance plan mandates any additional documentation or procedures, kindly inform us, and we will provide you with all the required information to ensure you receive the reimbursement you are entitled to.
Pre-Authorization*
A pre-authorization, also known as prior authorization or pre-certification, is a process where your healthcare provider needs to get approval from your insurance company before providing a specific treatment or service. Insurance companies require pre-authorization for certain services to ensure that they are medically necessary and appropriate before they agree to pay for them.
What questions should I ask my health insurance provider?
You may want to contact your health insurance provider to obtain a detailed understanding of what services are covered under your plan. It is important to note that each insurance plan has its own set of rules, restrictions, and requirements, which may vary depending on the type of plan you have. By reaching out to your insurance provider, you can ask about your specific coverage and what procedures need to be followed to receive reimbursement for out-of-network services. It is recommended that you obtain pre-authorization from your primary care physician, if required, prior to receiving services to ensure that you are eligible for reimbursement.
To obtain information on whether your health insurance provider covers out-of-network expenses and the reimbursement process, you can prepare the following list of information before making the call, and ask your provider the following questions:
Necessary Information
Insurance I.D. #
Group #
Name of Primary Subscriber on the Insurance
Your Relationship to Primary Subscriber
Primary Subscriber's Birthdate
Your Birthdate
Subscriber's Employer
Questions to Ask
Does my plan cover out-of-network expenses for feeding and orofacial myofunctional therapy?
If yes, what percentage of the out-of-network expenses will my plan cover?
Is there a limit to the amount of out-of-network expenses my plan will cover?
Is there a separate deductible or out-of-pocket maximum for out-of-network expenses?
How do I submit superbills to the plan for reimbursement? Do I need to get a form to attach them to?
What documentation do I need to provide in order to get reimbursed (e.g., preauthorization)?
Is there a time limit for submitting a claim for out-of-network expenses?
By asking these questions, you can get a better understanding of what your health insurance plan covers and what you need to do to get reimbursed for out-of-network expenses.