Getting Started at Pediatric Therapy Center

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):

  1. Please have your Primary Care Physician submit an authorization request for an evaluation.
  2. Once we receive an authorization we will contact you for scheduling.

 If you have a PPO plan:

  1. Please have your child’s pediatrician send a prescription and any medical records pertaining to the referral to our office.
  2. 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.
  3. 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:

  1. Please have your Primary Care Physician send a referral authorization form (RAF) to Pediatric Therapy Center.
  2. 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:_____________________________

  •   Please give the diagnosis to your insurance to be sure it is covered under your plan.

2.   My child is recommended to receive Speech, Occupational and/or Physical therapy so what do I need to proceed with services?

  •  Be sure to get a Pediatrician’s prescription.

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

Occupational Therapy             97165/97166/97167/96111     97110/97112/97530/97535
Physical Therapy                   97001 & 96111               97110 & 97112
Speech Language Therapy 92506/92521/92522/92523/96111                         92507

Link here for Services Fees: Fee Schedule 2017

CONTACTS

General questions on  the evaluation process please contact our main office @ (831) 684-1804.

 

Insurance billing                                                                 

Heather Stone 

heatherstoneptc@gmail.com

 

Speech Therapy                                                                                         

Claire Wallace, MA, CCC-SLP

claireptc@sbcglobal.net

(831) 684-1804 ext. 1001

 

Occupational or Physical Therapy                                                      

Keri Allen, MOT, OTR/L

keri@ptc-sc.com

 (831) 684-1804 ext. 1000

                                                                      Thank you for your interest in PTC!

Pediatric Therapy Center now has a blog!

Visit our blog for information on our weekly groups- themes, goals supported, pictures, and suggested activities

Contact Us

Call today for an appointment:

(831) 684-1804

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