*IMPORTANT: We might not be a Participating Provider for all HPHC, UHC & BCBS plans/products. Please contact your individual plan before filling out an intake form to verify coverage, benefits and our participation in your plan. Our NPI # is 1750429072, this will be required for participation verification by your plan.
You may have benefits for an out-of-network provider or belong to a POS/PPO plan that covers outside facilities. However, OTA may often not be covered by insurance due to the fact that we are a private facility and not affiliated with any hospitals or rehabilitation facilities. If your insurance company has told you that they will reimburse you for our services out of network, OTA will provide you with monthly invoices that you may submit to your insurance company to seek reimbursement. OTA does not bill insurance companies for which they are not participating providers.
If you have secondary health insurance (if another person in your household also has insurance), be sure to check with that insurance company about coverage.
It is your responsibility to understand your coverage and to obtain authorization, if needed, for any out of network services.
For all insurance for which we are a participating provider we will contact your insurance company to verify your eligibility for therapy benefits. It is important to note that the insurance companies will state that a quote to benefits does not guarantee coverage and that payment is subject to further approval.
We will determine if prior authorization or pre-certification is needed for services. If it is required, we will follow the steps necessary to obtain authorization for therapy services.
We will assist you with any other insurance questions you might have to the best of our ability.
We will provide guidance regarding additional financial resources that might be available to you.
Some of our services are not insurance reimbursable regardless of your insurance policy. We will be clear with you when scheduling any such service that will require an out-of-pocket expense.
Many insurance plans cover Occupational Therapy and Speech and Language Therapy services, but there may be certain 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 may have benefits for an out-of-network provider or belong to a POS/PPO plan that covers outside facilities. However, OTA may often not be covered by insurance due to the fact that we are a private facility and not affiliated with any hospitals or rehabilitation facilities. If your insurance company has told you that they will reimburse you for our services out of network, OTA will provide you with monthly invoices that you may submit to your insurance company to seek reimbursement. OTA does not bill insurance companies for which they are not participating providers.
If you have secondary health insurance (if another person in your household also has insurance), be sure to check with that insurance company about coverage.
It is your responsibility to understand your coverage and to obtain authorization, if needed, for any out of network services.
For all insurance for which we are a participating provider we will contact your insurance company to verify your eligibility for therapy benefits. It is important to note that the insurance companies will state that a quote to benefits does not guarantee coverage and that payment is subject to further approval.
We will determine if prior authorization or pre-certification is needed for services. If it is required, we will follow the steps necessary to obtain authorization for therapy services.
We will assist you with any other insurance questions you might have to the best of our ability.
We will provide guidance regarding additional financial resources that might be available to you.
Some of our services are not insurance reimbursable regardless of your insurance policy. We will be clear with you when scheduling any such service that will require an out-of-pocket expense.
OTA The Koomar Center does not require you to have a medical doctor refer you for services, but if you want services reimbursed by an insurance company, it is 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 preauthorization for services, the number of visits they will cover in a given day or other time period, and whether they require periodic re-evaluations. The client/parent is responsible for keeping track of these requirements. OTA will not be responsible for keeping track of this information for insurances where we are not a participating provider.
OTA will obtain the prior authorization for treatment for occupational therapy clients covered by HPHC and UHC-HP, and for speech and language clients covered by HPHC, UHC-HP, BCBS, and Mass General Brigham Health Plan.
and BCBS. Clients need to provide OTA with a Letter of Medical Necessity from their primary care physician.
If OTA is a participating (in network) provider of your insurance company you are required to pay your co-payment at the time of service.
All other clients receive services through OTA’s Comprehensive Treatment Plan (CTP). Under the terms of this plan, each month of service is prepaid (or the entire course of treatment may be prepaid). You may submit the paid invoices directly to your insurance company.
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