Insurance/Private Pay

Tricare, CIGNA, United Heathcare, Aetna and Kaiser Insurance

Sprouts Therapy is a contracted provider with Tricare, CIGNA, United Healthcare (Commercial Plans), Aetna and Kaiser insurance.

TRICARE: 

Tricare Prime Clients: Before beginning services with us, you will need to obtain an authorization through Tricare for occupational, physical and/or speech therapy services. Your doctor will need to submit a referral for services in order to obtain an authorization. We will submit claims and bill Tricare on your behalf. No shared cost if Sprouts Therapy is the servicing provider on the authorization. You will be responsible for any deductibles and non-covered services. We do require that you provide a credit card for us to keep on file, which is billed for no show fees, late cancellation fees, late pick up/drop off fees, non-insured sessions and/or co-payments and deductibles.
Tricare Select Clients: Your doctor will need to send Sprouts Therapy a referral for services. Our referral form can be found on our website. We will submit claims and bill Tricare on your behalf. Each session will have a coinsurance until deductible/annual out-of-pocket maximum is met. You will be responsible for all co-insurance, co-pays, deductibles and non-covered services.

United Healthcare (Commercial Plans), CIGNA, and Aetna Insurance: Please contact your insurance company for specifics regarding OT, PT and SLP therapy benefits. Coverage may be effected based on client diagnoses. We will bill your insurance company for services rendered. We do require that you provide a credit card for us to keep on file, which is billed for no show fees, late cancellation fees, late pick up/drop off fees, non-insured sessions and/or co-payments, coinsurance and deductibles.

Kaiser Clients:
Sprouts Therapy is in-network with Kaiser HMO, Added Choice, Medicaid and Medicare plans. You will need to obtain an authorization to Sprouts for pediatric Speech, Occupational and/or Physical Therapy. You will need to inform your PCM that you would like to receive pediatric SLP/OT/PT/Feeding services from Sprouts Therapy. If approved, you will most likely obtain an authorization for an evaluation and 12 treatment sessions. At that point, we can send a progress report to your doctor to receive approval for additional sessions. Kaiser will pay Sprouts Therapy direct for services, and you would only be responsible for the copays or coinsurance that apply to your plan. We do require that you provide a credit card for us to keep on file, which is billed for no show fees, late cancellation fees, late pick up/drop off fees, non-insured sessions and/or co-payments, coinsurance and deductibles.




HMSA

We are an out of network provider for HMSA. You will be required to pay for sessions up front and in full. We do require that you provide a credit card for us to keep on file, as we
will bill you for all accumulated sessions and charges once a week. 

PPO Clients: HMSA allows 8 OT sessions with partial reimbursement directly to the subscriber before a prior authorization is required. All SLP and PT sessions require prior authorization ahead of time, HMSA will reimburse member for initial evaluation. HMSA does not approve prior authorizations for diagnosis' that are considered "developmental delays." However, if you child has a DSM-5 Autism diagnosis, HMSA may approve additional OT, PT and ST services. 

HMO/Quest Clients: HMSA will not reimburse for any services provided by Sprouts Therapy.

Sprouts Therapy can provide coded invoices upon request that you can submit to your insurance company for reimbursement. However, we cannot guarantee reimbursement and you will be responsible for all disputes with your insurance company regarding coverage and reimbursement.

For a small fee, we can submit claims to HMSA on your behalf. However, we cannot guarantee reimbursement.

All other Insurance Companies

We are an out-of-network provider for United Healthcare Community Plans, UHA, HMAA, HMA, and all other insurances not previously listed. You will be required to pay for sessions up front and in full. We do require that you provide a credit card for us to keep on file, as we will bill you for all accumulated sessions and charges once a week.

Sprouts Therapy can provide coded invoices upon request that you can submit to your insurance company for reimbursement. However, we cannot guarantee reimbursement and you will be responsible for all disputes with your insurance company regarding coverage and reimbursement.

Private Pay

For all clients without Tricare, Cigna, UHC Commercial, Aetna or Kaiser you will be responsible for the full payment of your sessions. We do require that you provide a credit card for us to keep on file, as we will bill you for all accumulated sessions once a week.
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