Welcome! We are so happy to have the opportunity to meet you and your child. Please reference the following information regarding insurance questions.
If you have an HMO plan (We are ONLY contracted with Physician’s Medical Group):
- Please have your Primary Care Physician submit an authorization request for an evaluation.
- Once we receive an authorization we will contact you for scheduling.
If you have a PPO plan:
- Please have your child’s pediatrician send a prescription and any medical records pertaining to the referral to our office.
- Please refer to the questions in the box below when calling your insurance company, verifying if therapy is a covered benefit and what your out-of-pocket expense would be.
- You will be paying Pediatric Therapy Center at the time of service, and billing your insurance for reimbursement.
**Reminder: We do not bill your insurance company for your child’s therapy. You will receive a receipt stating diagnostic and procedure codes. You will be able to use that receipt when submitting your claim to your insurance company.
If you have Central Coast Alliance for Health:
- Please have your Primary Care Physician send a referral authorization form (RAF) to Pediatric Therapy Center.
- Once we receive the referral (RAF) at our office, we will be contacting you for scheduling.
Questions for your Insurance Carrier
***When talking to your insurance company, be sure to take notes and get the name and extension of whom you are talking to
1. Under what conditions are Speech, Occupational and/or Physical therapy covered under your plan? What types of conditions/diagnosis are excluded? My child’s Doctor has stated this diagnosis:_____________________________
2. My child is recommended to receive Speech, Occupational and/or Physical therapy so what do I need to proceed with services?
3. I am interested in a provider who is “out of network”. How do I obtain those services and get “in network rates”? (As there are no other Pediatric Therapy specialists in my area.)
4. I have spoken to a pediatric outpatient practice that has suggested these possible procedural codes for my child. Are they covered under the plan?
5. Do I have a deductible?
6. Are there any limitations or exclusions under my plan for therapy?
7. Let your insurance know that you, as the member, will be billing them for reimbursement and what is the process?
If any further questions come up when speaking to your insurance company, do not hesitate to call us for further information or support.
Evaluation CPT codes Treatment CPT codes
|Physical Therapy||97001 & 96111||97110 & 97112|
|Speech Language Therapy||92506/92521/92522/92523/96111||92507|
Link here for Services Fees: Fee Schedule 2017
General questions on the evaluation process please contact our main office @ (831) 684-1804.
Claire Wallace, MA, CCC-SLP
(831) 684-1804 ext. 1001
Occupational or Physical Therapy
Keri Allen, MOT, OTR/L
(831) 684-1804 ext. 1000
Thank you for your interest in PTC!