New Horizons Wellness Services in Tigard Oregon is not in network with commercial insurance companies. As a result, we don’t directly bill insurance companies. Instead, we provide you with an itemized receipt referred to as a “Superbill”. This contains the information your insurance company will need to process your claim.
For occupational therapy and speech therapy, the clinic is providing services for Blue Cross, Blue Shield, and Regence until 2024. Some members with Kaiser may also receive authorization to receive services at our clinic on a case by case basis. This authorization is generated through the Kaiser system.
Why Do We Not Accept Insurance?
While it might sound surprising that we are not in network or don’t directly bill insurance companies, it actually has benefits for you, the patient.
Overall, we can provide more effective individualized care for more families by being private pay.
Our goal is to treat a client for however much time they need, as often as they need, and for as long as is necessary versus an arbitrary number of visits dictated by insurance.
Insurance companies only pay for services that they consider to be “medically necessary”. This means that someone has to actually diagnose you or your child with a medical or mental health disorder and prove it’s impacting your or your child’s health on a day to day basis. Fortunately, many individuals and parents seek treatment before the issue would meet criteria for diagnosis as a medical or mental health disorder. It is customary for your insurance company to tell you, “a quote of benefits does not guarantee payment”. In short, this means that you can be told over the phone that something is covered. You can be given an authorization number. You are often still denied once they review the diagnosis.
Another issue is that we are required to give a medical or mental health diagnosis code in order to receive reimbursement for services provided. This is unethical if in fact you or your child does not meet criteria for a diagnosis. This process also requires us to provide access to your or your child’s diagnosis, treatment plan and treatment notes to a third party.
Lastly, most insurance companies do not cover testing for developmental delays or language based learning disabilities. We have learned over the years that preapprovals involve the companies granting approval for each individual test we feel should be administered, prior to the start of our testing process. But we tailor our assessments to you or your child and address the referral question. As a result, we often make adjustments to the assessment measures used in our test battery after we start the testing process, rather than administering the same test to each individual. This individualized assessment approach does not fit in with the insurance preapproval process.
Do We Accept Oregon Health Plan, Medicaid, Or Medicare?
We do not accept OHP, Medicaid, or Medicare insurance (primary or secondary), and we cannot accept cash payments from patients who have this coverage.
What Is Your Payment Process?
We accept cash, debit, Visa, MasterCard, Discover, American Express, health saving account (HSA), and flex savings accounts (FSA).
We do not accept checks.
Due to legal and ethical requirements, patients are not allowed to carry account balances as doing so can negatively impact clinical work. This means that full payment is due at the time services are rendered. For therapy, this means the cost of therapy is due at the end of the session.
We’ll keep your card information on file. Your card will only be charged the amount that you are deemed responsible for (e.g., one time charge, monthly payment plan, etc.).
How Do I Get My Itemized Receipt (Superbill)?
We can provide you with a superbill to submit to your insurance for possible reimbursement based on your plan. It contains the information your insurance company needs to understand potential reimbursement and preauthorization requirements
You can find your superbill in your patient portal. This itemized receipt contains information your insurance company needs to process your claim (i.e., dates/hours of service; CPT codes; diagnostic codes; the EIN number or tax ID#; state license and national provider numbers).
It’s important to speak with your insurance company and to know your benefits prior to starting care, as some insurance companies require preauthorization for services. While many patients are successful in seeking reimbursement for a portion of the fees, reimbursement is considered a matter between you and your insurance company. We do not participate in appeals of decisions or any other negotiations with insurance companies.
What is a Good Faith Estimate?
Effective January 1, 2022, you have the right to receive a “good faith estimate” explaining how much your medical care will cost.
At New Horizons Wellness Services, we provide good faith estimates as part of our onboarding process for new patients and before an initial appointment is scheduled.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
A good faith estimate shows the costs of services that are reasonably expected for your healthcare needs for an item or service. The estimate is based on information known at the time the estimate was created. Please be advised, your fee may change depending on the number of sessions you actually attend. Services outside of standard therapy or assessment may have an associated extra cost.
Please refer to our practice policies page for a complete list of fees and services. We will provide you with a good faith estimate in writing at least 1 business day before your medical or mental health service or item.
You can also ask for a good faith estimate before you schedule a service. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
For questions or more information about your right to a good faith estimate or the dispute process, visit www.cms.gov/nosurprises or call 1-877-696-6775.
What Are Your Fees?
Our speech therapy and occupational therapy rate range from $125 – $275 per session.
Our group and counseling rates range from $125-$235 per session.
Our comprehensive psychological assessment and testing services are billed at an hourly rate of $250.
Most evaluations require a total of 9-15 hours of services.
The total cost of a New Horizon Wellness Services comprehensive evaluation typically ranges from $2346 to $3896, depending on the scope and complexity.
Questions? Contact New Horizons Wellness Services
If you need clarification about any of the information above, we’re happy to help.