Out-of-Network Insurance Reimbursement Guide
Tumble N’ Dots is not an in-network provider with your insurance company.
In some cases, the total cost of the evaluation and/or therapy sessions is reimbursed, however, benefits depend on your insurance coverage and other factors.
We will provide you with a superbill that includes all the insurance codes needed to seek reimbursement from your insurance carrier.
Since we do not bill your insurance for you or receive any reimbursement from your insurance carrier, payment in full is due regardless of any insurance claims.
How to Check for Out-of-Network Coverage and Benefits
Call your insurance company. The customer line should be available on the back of your insurance card.
Ask the health insurance company representative the following questions:
- Does my plan include out-of-network coverage for occupational therapy and/or speech therapy?
- Do I have an annual deductible for out-of-network services?
- If yes, what is the deductible?
- How much of the out-of-network deductible was already met?
- Is there a limit to the number of therapy sessions the plan will cover per year?
- Is there a limit on out-of-pocket expenses per year?
- What is the coinsurance percentage for therapy?
- Do I need a referral for therapy services?
- Can I submit a superbill for reimbursement? if so, how?
Provide with the following information if asked about the service provider:
- Company Name: Tumble N’ Dots
- Tax ID (EIN): 81-3640988
- NPI Number: 1376045385
- Address: 16 Technology Drive, #142, Irvine CA 92618
- Phone Number: (949) 835-3746
The health care representative might ask for a CPT code (Clinical Procedure Terminology) for the therapy services.
- 99368 – Professional Consultation (In-Direct)
- 97530 – Occupational Therapy – Theraputic Activities
- 97166 – Occupational Therapy – Evaluation, Moderate Complexity
- 92507 – Speech – Language Treatment Individual
- 92523 – Speech – Language Evaluation: Low Complexity
- 97150 – Group Theraputic Procedures
Out-of-network reimbursement is the client’s responsibility. In the event the insurance company requests additional documentation, we will work with you to provide the necessary documentation. However, this can be very time-consuming, and thus, any support for your out-of-network reimbursement that requires an excess of 15 minutes of your therapist’s time will be billed to you per our billing policy.