Insurance/Private Pay

Tricare, CIGNA, United Heathcare, and Aetna Insurance

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

TRICARE: Before beginning services with us, you will need to obtain an authorization through Tricare for occupational, physical and/or speech therapy services. You will need to provide your insurance with a medical referral or prescription from your child’s pediatrician in order to obtain this. 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 Prime Clients: 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.
Tricare Standard Clients: 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.




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/PT sessions with partial reimbursement directly to the subscriber before a prior authorization is required. All SLP 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, Kaiser 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.

Kaiser Clients:
Sprouts Therapy is not in-network with Kaiser currently, however, you may be able to receive an outside referral to Sprouts for pediatric Occupational and or Physical Therapy. Kaiser will refer to an outside provider if they are unable to provide the services internally. You will need to inform your PCM that you would like to receive pediatric OT/PT/Feeding services from Sprouts Therapy. If approved, your PCM will most likely refer your child to Sprouts Therapy 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. If Kaiser will not provide a referral to Sprouts Therapy, then all services will be out of pocket.


Private Pay

For all clients without Tricare, Cigna, UHC Commercial or Aetna 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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