Commercial Insurance Teletherapy Acknowledgment Commercial Insurance Teletherapy Acknowledgment Patient's Name First Last Parent's Name First Last Terms of Service*Important COVID-19 Insurance Updates Patients that are covered with Blue Cross Blue Shield, Cigna, Humana, and United Healthcare: This week these companies are beginning to revise their members plans to make changes for COVID-19 and making teletherapy available as a covered service for some patient plans. We are asking families to call their benefits department and ask if teletherapy is something that is considered a covered service for your child’s speech, occupational, and/or physical therapy. When making a call to your insurance company, it’s best to get a reference number for a record of the phone conversation and to be able to have it easily pulled back up. If they say they will cover therapy, please reach out to your therapist(s) and/or our front office to assist you further. Although our office will work diligently to get your insurance claim processed, please understand that the insurance’s quote of benefits is not a guarantee of claim payment. Based on how they process the claim you could potentially be liable for charges and our office wants you to know that we will work with families during this time period. We offer a prompt pay discount in the event the insurance does not process the claims that comes out to be a $55 copay per 30-minute treatment session. We are asking at this time you sign an updated online form to acknowledge your responsibility on verifying the benefit and any charges associated with denied claims. We will continue to do our best to provide your children with services and thankful insurance companies are starting to put changes in place to make that possible during this time. I agree to the terms described above Please sign below to acknowledge these insurance updates as of March 26, 2020Signature* Reset signature Signature locked. Reset to sign again Date* MM slash DD slash YYYY Δ