Insurance & Payment Information

Project CHILLD is an occupational therapy and speech language pathology preferred service provider for both Harvard Pilgrim and Blue Cross Blue Shield of Massachusetts.

We are happy to support you in obtaining insurance reimbursement for occupational therapy services (OT) received at our office.

Project CHILLD will:

  • Submit charges to your insurance company in a timely manner Provide you with (CPT) billing codes and diagnosis codes for services your child will receive. Sometimes this can help determine coverage.
  • Follow up with your insurance company if charges are denied and resubmit those charges with appropriate paper work.
  • Provide you with all correspondence between Project CHILLD and your insurance company (upon request)
  • Move balances to private pay if payment is not received in a timely manner, including but not limited to the following reasons: benefit exhausted, charges denied, denied on appeal, and/or you do not have coverage.

Client responsibility:

  • Understand your benefits. Call the telephone number on the back of your insurance card to obtain information.
  • Obtain any necessary referrals, physician’s prescription, and/or letter of medical necessity.
  • Monitor your remaining referral visits. The office or your therapist can assist you. You can also check with your insurance company. BCBSMA members can check online at www.bcbsma.com to know how many visits remain.
  •  Provide us with a current copy of your insurance card.
  • Follow up with your insurance company if payment is denied. You will usually receive notification from your insurance company and Project CHILLD will note the denial on your billing statement.
  • Pay your copayment, co-insurance and deductibles at the time of visit.
  • Pay insurance balances if payment is not received in a timely manner, including but not limited to the following reasons: benefit exhausted, charges denied, denied on appeal, and/or you do not have coverage.

As insurance coverage changes from year to year, it is best to verify your benefits at the time your insurance is renewed.


If your plan requires a referral:
The following information is important:

  • If we do not receive a referral, you may be responsible for payment of the session.
  • OT visits at other facilities will count toward your total yearly benefit.
  • Sometimes OT, PT and Speech are combined as one benefit.

For BCBS

  • Call your primary care physician (PCP) for a referral.
  • Most plans will allow the PCP to approve 8 visits per calendar year.
    If your PCP issues a referral for < 8 visits, remember to get additional referrals to cover visits beyond the original referral.
  •  A new referral is required at the beginning of each calendar year. Make sure the referral is in place at the time of your first visit of each new calendar year.
  • BCBSMA HMO plans require a medical review before granting visits beyond 8. If an extension is denied or services are not covered, Project CHILLD will bill you directly.

For Harvard Pilgrim

  • Call your insurance company to verify that your plan covers occupational therapy. Each plan is different; you may have a 30, 60, or 90 day benefit. This benefit may be a lifetime, yearly, or per condition benefit.

Non-covered services:

  • BCBS and HP cover a brief 1 hour OT evaluation only. A more comprehensive evaluation is not covered by BCBS or HP. If your child receives any evaluation other than the brief evaluation, we cannot bill your insurance company. The cost will be billed directly to the responsible party.
  • Sound Therapy and Neurofeedback are not covered by insurance.

Out-of-State and Administrative Services Only (ASO) plan benefits differ from BCBSMA:

  • It is especially important to understand your benefits for these plans. Project CHILLD is considered a preferred provider for plans that show a “suitcase” display on front of card, and we can submit through BCBSMA, but cannot guarantee that services will be reimbursed. Plans without a “suitcase” do not consider BCBSMA providers as preferred providers.
  • You will be responsible for any services not reimbursed by your insurance.
  • We are happy to submit charges, but do understand, that you will be billed directly for any unpaid charges or outstanding balances.

Other Insurance Companies:

1. Project CHILLD is considered an out-of-network or non-participating provider for all other insurance.

2. Some insurance plans might cover services, if

  • You have an occupational therapy benefit
  • Your policy allows you to receive services from an out-of-network provider.
  • Services are not excluded from coverage (rehabilitation only)

 
3. We suggest that you keep accurate notes when you call your insurance company.

4. Questions to ask your insurance company:

  • Can my child receive OT services from a non-participating provider?
  • What is the benefit or “allowed amount” of coverage? (3 months? 30 visits? Dollar amount?)
  • Do I need insurance company approval or review before accessing these benefits?
  • Is there a deductible, co-insurance, co pay, etc?
  • Do I need a prescription, referral, or preauthorization from my PCP?

 
5. Project CHILLD will bill for any deductibles, co-insurance payments or the balance of any other unpaid services

Disclaimers:

  • Verification of coverage is not a guarantee of coverage. 
  • This information is offered as a guideline only. All insurance plans are purchased by you or your employers and the details of coverage are specific to that plan.