Insurance and Fees

Insurance Options

Raleigh Therapy Services currently accepts:

  • Aetna
  • BlueCross BlueShield of North Carolina
  • Cigna
  • Medicaid
  • NC Health Choice
  • State Employees Health Plan
  • Tricare
  • United Healthcare
  • We are also contracting providers with surrounding CDSAs.

Please be sure to ask about your insurance carrier if you do not see it on our list. We are in the process of adding other insurance companies.

You may be eligible to receive out of network benefits from your insurance carrier. To see if you are eligible, call the customer service number on the back of your insurance card.

If you have insurance concerns, please contact your insurance provider or our office for more information.

Common Insurance Terminology

Allowed Charges-Amount an insurance company will reimburse an in-network provider for services rendered to their client.

Authorization-Approval from insurance provider for a covered service to be eligible for payment.  Often takes 5-7 business days and allows for a maximum number of sessions within a certain time-period.

Co-insurance-The client may be required to pay a certain % of the allowed charges as required by his/her contract with the insurance provider.  For example, an insurance provider may 90% and the client may be required to pay 10% of the allowable charges.

Co-pay-The dollar amount a client is required to pay for each date of service.

Explanation of Benefits (EOB)-A description of claims processed by the insurance provider.  EOBs typically include the following information: type of service, date(s) of service, billed charges, payments, reasons for denial, and patient responsibility.  It is very important that you read your EOBs as we do not track benefit caps on therapy services.

Financial Policies

INSURANCE: Professional services are rendered and charged to you, not your insurance company. Please understand that the contract is between you and your insurance company and payment for services is your responsibility. Each company negotiates different benefits and clients are responsible for understanding their individual policies. We will only file claims to insurance companies for which we are in network; however we will supply you with any paperwork needed for you to submit your claim.

 Special financial arrangements must be made with the Office Manager prior to starting treatment. Our office will not enter into a dispute with your insurance company over your claim.  You will receive a statement that is mailed at the 1st of each month that shows a balance due, regardless of insurance expectations. If at the end of sixty (60) days, your insurance has not paid, you will be responsible for the entire balance.

It is your responsibility to inform us of any changes in your address, phone numbers, employment and medical benefits.

In order for us to honor your insurance, we must be able to verify your coverage and current benefits. If verification cannot be made you will be responsible for the full charges to be paid at the time of service.

CO PAYMENTS AND CREDIT CARD AUTHORIZATION: Your health insurance policy may state that you must pay a co-payment for therapy evaluations and sessions. This payment is due the day services are rendered to your child/children. Raleigh Therapy Services has a contractual agreement with the health insurance carriers to collect all co-pays on the date the services are rendered.

In order to satisfy our contractual agreements with health insurance companies and accept your insurance, we require that patients leave a valid open credit card with a signature on file, authorizing Raleigh Therapy Services, Inc. to bill that card for the co-payment amount assigned by your insurance company for each therapy evaluation and session conducted.  This amount is clearly listed on the Explanation of Benefits (EOB) form which is sent to you by the insurance company after each visit.  Credit Card information will be stored in a professional, secure credit card system.  You will receive a receipt on a monthly basis which lists charges made to your card for services rendered that month.  Should you provide us with a credit card that is declined, services for your child/children will be placed on hold until you can provide us with a valid credit card. We cannot guarantee that services will be resumed immediately and your child/children may be placed on a waiting list.  Raleigh Therapy Services accepts Visa, MasterCard and Discover.  If your child is seen in the office, you do have the option of paying co-payments and fees at the time of service.

MEDICAID: Medicaid is the payer of last resort. If your child is covered by any other insurance, your primary insurance must be billed first. If your Primary insurance denies coverage because you are seeing an “out of network” provider, Medicaid will not pay for the therapy. If your primary insurance does not cover therapy, you must obtain a “letter of denial” before we can begin therapy or you have the option of paying privately. It is imperative that you inform us immediately if you change insurance companies at any time. Any non-payment from Medicaid will be the responsibility of the parents.

NON-PAYMENT: If payment is not made, we will either hold or terminate services. The account must be paid in full before therapy can be resumed.

BROKEN APPOINTMENT POLICY: Please consider your scheduled appointments carefully. We require a 24-hour cancellation notice. If we do not receive a 24-hour cancellation notice you may be charged a $30 broken appointment fee that will not be paid by your insurance company. If you repeatedly miss your scheduled appointments therapy may be terminated at our discretion.

BILLING ADMINISTRATION FEE: A $5 fee will be assessed and applied to your account each time more than one bill, for the same balance, has to be generated and sent. 

Fees for Services

We offer the option of paying out-of-pocket for an evaluation and any necessary treatment sessions for those families without insurance or whose insurance company does not offer benefits for therapy services. Our fees are as follows:

Speech and Language Therapy Fees

Screening FREE
Comprehensive Evaluation (including written report and treatment plan) $200.00
Speech Therapy Session $100.00
Feeding Therapy Session $100.00
Augmentative/Alternative Communication Device Training/Programming $100.00

Physical and Occupational Therapy Fees

Screening FREE
Comprehensive Evaluation (including written report and treatment plan) $200.00
60-Minute Therapy Session $150.00
45-Minute Therapy Session $120.00
30-Minute Therapy Session $90.00

 

Notice of Privacy Policies

Effective:  September 29, 2011

 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

This notice will tell you how RALEIGH THERAPY SERVICES, INC. may use and disclose protected health information about you.  Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you.  In this notice, we call all of that protected health information, “medical information.”

This notice also will tell you about your rights and our duties with respect to medical information about you.  In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.

How We May Use and Disclose Medical Information About You

We use and disclose medical information about you for a number of different purposes. Each of those purposes is described below.

For Treatment

We may use medical information about you to provide, coordinate or manage your health care and related services by both us and other health care providers.  We may disclose medical information about you to doctors, nurses, hospitals and other health facilities who become involve in your care.  We may consult with other health care providers concerning you and as part of the consultation share your medical information with them.  Similarly, we may refer you to another health care provider and as part of the referral share medical information about you with that provider.  For example, we may conclude you need to receive services from a physician with a particular specialty.  When we refer you to that physician, we also will contact that physician’s office and provide medical information about you to them so they have information they need to provide services for you.

For Payment

We may use and disclose medical information about you so we can be paid for the services we provide to you.  This can include billing you, your insurance company, or a third party payor.  For example, we may need to give your insurance company information about the health care services we provided to you so your insurance company will pay us for those services or reimburse you for amounts you have paid.  We also may need to provide your insurance company or a government program, such as Medicare or­ Medi­caid, with information about your medical condition and the health care you need to receive to determine if you are covered by that insurance or program.

For Health Care Operations

We may use and disclose medical information about you for our own health care operations.  These are necessary for us to operate RALEIGH THERAPY SERVICES, INC and to maintain quality health care for our patients.  For example, we may use medical information about you to review the services we provide and the performance of our employees in caring for you.  We may disclose medical information about you to train our staff, volunteers and students working at RALEIGH THERAPY SERVICES, INC.  We also may use the information to study ways to more efficiently manage our organization.

How We Will Contact You

Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace.  At either location, we may leave messages for you on the answering machine or voice mail.  If you want to request that we communicate to you in a certain way or at a certain location, see, “Right to Receive Confidential Communications” on page 5 of this Notice.

Appointment Reminders

We may use and disclose medical information about you to contact you to remind you of an appointment you have with us.

Treatment Alternatives 

We may use and disclose medical information about you to contact you about treatment alternatives that may be of interest to you.  If you want to opt out of such communications at any time, please notify RALEIGH THERAPY SERVICES, INC.­ in writing.

 Health Related Benefits and Services

We may use and disclose medical information about you to contact you about health-related benefits and services that may be of interest to you. If you want to opt out of such communications at any time, please notify RALEIGH THERAPY SERVICES, INC. in writing.

Marketing Communications

We may use and disclose medical information about you to communicate with you about a product or service to encourage you to purchase the product or service.  This may be:

  • To describe a health-related product or service that is provided by us;
  • For your treatment;
  • For case management or care coordination for you;
  • To direct or recommend alternative treatments, therapies, health care providers, or settings of care.

We may communicate to you about products and services in a face-to-face communication by us to you.

All other use and disclosure of medical information about you by us to make a communication about a product or service to encourage the purchase or use of a product or service will be done only with your written authorization.  If the communication involves direct or indirect financial remuneration (other than payment for your treatment) to RALEIGH THERAPY SERVICES, INC from a third party whose product or service is being described, the authorization will state that such remuneration is involved.

Individuals Involved in Your Care

We may disclose to a family member, other relative, a close personal friend, or any other person identified by you, medical information about you that is directly relevant to that person’s involvement with your care or payment related to your care.  We also may use or disclose medical information about you to notify, or assist in notifying, those persons of your location, general condition, or death.  If there is a family member, other relative, or close personal friend that you do not want us to disclose medical information about you to, please notify RALEIGH THERAPY SERVICES, INC. or tell our staff member who is providing care to you.

Required by Law

We may use or disclose medical information about you when we are required to do so by law.

Health Oversight Activities

We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplin­ary actions.  These and similar types of activities are necessary for appropriate oversight of the health care system, government benefit programs, and entities subject to various government regulations.

Judicial and Administrative Proceedings

We may disclose medical information about you in the course of any judicial or adminis­trative proceeding in response to an order of the court or administrative tribunal.  We also may disclose medical information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.

Disclosures for Law Enforcement Purposes

We may disclose medical information about you to a law enforcement official for law enforcement purposes:

  1. As required by law.
  2. In response to a court, grand jury or administrative order, warrant or subpoena.
  3. To identify or locate a suspect, fugitive, material witness or missing person.
  4. About an actual or suspected victim of a crime and that person agrees to the disclosure.  If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be disclosed.
  5. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.
  6. About crimes that occur at our facility.
  7. To report a crime in emergency circumstances.

Other Uses and Disclosures

Other uses and disclosures will be made only with your written authorization.  You may revoke such an authorization at any time by notifying RALEIGH THERAPY SERVICES, INC. in writing of your desire to revoke it.  However, if you revoke such an authorization, it will not have any effect on actions taken by us in reliance on it.

Certain Uses and Disclosures that Require Your Written Authorization

Documentation.  Your authorization is required before we may use or disclose documentation (including but not limited to evaluation reports, treatment plans, visit notes, progress reports, and/or discharge summaries) unless the use or disclosure is: (a) by the originator of the documentation for treatment; (b) for our own training programs for students, trainees, or practitioners in allied health; (c) to defend ourselves in a legal action or other proceedings brought by you; (d) when required by law; or, (e) permitted by law for oversight of the originator of the documentation.  

Your Rights With Respect to Medical Information About You

You have the following rights with respect to medical information that we maintain about you.                                              

Right to Request Restrictions

You have the right to request that we restrict the uses or disclosures of medical information about you to carry out treatment, payment, or health care operations.  You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) to public or private entities for disaster relief efforts.  For example, you could ask that we not disclose medical information about you to your brother or sister. To request a restriction, you may do so at any time. If you request a restriction, you should do so to RALEIGH THERAPY SERVICES, INC. and tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse). With one exception, we are not required to agree to any requested restriction.  The exception is that we will always agree to a request to restrict disclosures to a health plan if: (a) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and, (b) the information relates solely to a health care item or service for which you, or someone on your behalf (other than the health plan) has paid us in full.  If we agree to a restriction, we will follow that restriction unless the information is needed to provide emergency treatment.  Even if we agree to a restriction, either you or we can later terminate the restriction.

Right to Receive Confidential Communications

You have the right to request that we communicate medical information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work.  We will not require you to tell us why you are asking for the confidential communication. If you want to request confidential communication, you must do so in writing to RALEIGH THERAPY SERVICES, INC. Your request must state how or where you can be contacted. We will accommodate your request.  However, we may, when appropriate, require information from you concerning how payment will be handled.  We also may require an alternate address or other method to contact you.

Right to Inspect and Copy  

With a few very limited exceptions, such as documentation, you have the right to inspect and obtain a copy of medical information about you. To inspect or copy medical information about you, you must submit your request in writing to RALEIGH THERAPY SERVICES, INC. Your request should state specifically what medical information you want to inspect or copy.  If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing. We will act on your request within thirty (30) calendar days after we receive your request.  If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies. We may deny your request to inspect and copy medical information if the medical information involved is:

  1. Documentation;
  2. Information compiled in anticipation of, or use in, a civil, criminal or administra­tive action or proceeding;

If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed, and how you may complain.  If you request a review of our denial, it will conducted by a licensed health care professional designated by us who was not directly involved in the denial.  We will comply with the outcome of that review.

Right to Amend

You have the right to ask us to amend medical information about you.  You have this right for so long as the medical information is maintained by us.  To request an amendment, you must submit your request in writing to RALEIGH THERAPY SERVICES, INC. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within sixty (60) calendar days after we receive your request.  If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying. If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons.  We also will make the appropriate amendment to the medical informa­tion by appending or otherwise providing a link to the amendment. We may deny your request to amend medical information about you.  We may deny your request if it is not in writing and does not provide a reason in support of the amendment.  In addition, we may deny your request to amend medical information if we determine that the information:

  1. Was not created by us, unless the person or entity that created the information is no longer available to act on the requested amendment;
  2. Is not part of the medical information maintained by us;
  3. Would not be available for you to inspect or copy; or,
  4. Is accurate and complete.

If we deny your request, we will inform you of the basis for the denial.  You will have the right to submit a statement of disagreement with our denial.   We may prepare a rebuttal to that statement.  Your request for amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will then be appended to the medical information involved or otherwise linked to it.  All of that will then be included with any subsequent disclosure of the information, or, at our election, we may include a summary of any of that information. If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the medical information involved. You also will have the right to complain about our denial of your request.

Right to an Accounting of Disclosures  

You have the right to receive an accounting of disclosures of medical information about you.  The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before July 1, 2007.

Certain types of disclosures are not included in such an accounting:

  1. Disclosures to carry out treatment, payment and health care operations;
  2. Disclosures of your medical information made to you;
  3. Disclosures that are incident to another use or disclosure;
  4. Disclosures that you have authorized;
  5. Disclosures for our facility directory or to persons involved in your care;
  6. Disclosures for disaster relief purposes;
  7. Disclosures for national security or intelligence purposes;
  8. Disclosures to correctional institutions or law enforcement officials having custody of you;
  9. Disclosures that are part of a limited data set for purposes of research, public health, or health care operations (a limited data set is where things that would directly identify you have been removed);
  10. Disclosures made prior to July 1, 2007.

Under certain circumstances your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended.  Should you request an accounting during the period of time your right is suspended, the account­ing would not include the disclosure or disclosures to a law enforcement official to a health oversight agency. To request an accounting of disclosures, you must submit your request in writing to  RALEIGH THERAPY SERVICES, INC. Your request must state a time period for the disclosures.  It may not be longer than six (6) years from the date we receive your request and may not include dates before July 1, 2007. Usually, we will act on your request within sixty (60) calendar days after we receive your request.  Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary. There is no charge for the first accounting we provide to you in any twelve (12) month period.  For additional accountings, we may charge you for the cost of providing the list.  If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee.                                              

Right to Copy of this Notice

You have the right to obtain a paper copy of our Notice of Privacy Practices.  You may obtain a paper copy even though you agreed to receive the notice electronically.  You may request a copy of our Notice of Privacy Practices at any time.

Our Duties

Generally

We are required by law to maintain the privacy of medical information about you and to provide individuals with notice of our legal duties and privacy practices with respect to medical information.  We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.

Our Right to Change Notice of Privacy Practices

We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice.          

Availability of Notice of Privacy Practices

A copy of our current Notice of Privacy Practices will be posted in the lobby of our office.   A copy of the current notice also will be posted on our website, www.raleights.com.  At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting RALEIGH THERAPY SERVICES, INC.

Effective Date of Notice

he effective date of the notice is stated on the first page of the notice.

Complaints

You may complain to us and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by us. To file a complaint with us, contact RALEIGH THERAPY SERVICES, INC. All complaints should be submitted in writing. To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201.  Complaints also may be filed online. Go to: http://www.hhs.gov/ocr. You will not be retaliated against for filing a complaint.