Irvine Therapy Services is in-network with Aetna PPO for Occupational Therapy and Speech Therapy services. All other insurance plans are considered out-of-network. In these cases, we provide insurance super bills for you to submit to your insurance for reimbursement if your plan is eligible. Many plans are eligible for reimbursement, and some up to 80% of the cost of the out-of-network expense once the deductible has been met.
Guidelines for Inquiring about Insurance Reimbursement:
You can inquire in advance regarding out-of-network reimbursement by calling the member hotline listed on your insurance card and using these questions as a guide for gathering information specific to your plan:
1. Does my plan cover out-of-network therapy services?
You want to confirm whether your insurance policy covers therapy from providers who aren’t within the plan’s network.
The following is the service provider information specific to Irvine Therapy Services, Inc, which you can provide if requested by the representative:
- Company Name: Irvine Therapy Services, Inc.
- Address: 16631 Noyes Avenue, Irvine CA 92606
- Phone Number: (949) 252-9946
- Tax ID (EIN): 33-0971660
- NPI Number: 1003932781
- Taxonomy Codes:
- 225XP0200X – Occupational Therapist – Pediatrics
- 235Z00000X – Speech-Language Pathologist
Therapy Code: The representative may ask which CPT code (Clinical Procedure Terminology) will be used for therapy services.
- 97167– Occupational Therapy Evaluation- High Complexity
- 97530 (4 units)– Occupational Therapy Treatment- Therapeutic Activities
- 92523– Speech and Language Evaluation
- 92507– Speech and Language Treatment
2. What percentage of the therapy session cost will the insurance cover for out-of-network providers?
- This question will help you understand how much of the session cost will be covered by insurance, typically as a percentage (e.g., 50%, 70%).
3. What is my out-of-network deductible?
- Many insurance plans require you to meet an out-of-network deductible before they start covering services. Clarifying this amount is important so you know what you’ll be responsible for upfront.
4. Is there a limit on the number of out-of-network therapy sessions covered?
- Some plans may limit the number of out-of-network therapy sessions per year or impose caps on the total amount they will reimburse.
5. What is the reimbursement rate for out-of-network therapy providers?
- Find out the reimbursement rate or how much the insurance company will pay per session for an out-of-network provider. For example, some plans may reimburse at a lower rate than what they would pay an in-network provider.
6. Do I need to get pre-authorization or a referral for out-of-network therapy services?
- Some insurance plans require pre-authorization or a referral from a primary care physician to access out-of-network benefits.
7. How do I submit a claim for out-of-network therapy services?
- Ask about the process for submitting claims for out-of-network therapy. Some plans may require you to pay upfront and then submit the claim for reimbursement, while others may handle this differently.
8. What documents do I need to submit for reimbursement?
- Ask what documentation you’ll need to provide when submitting for reimbursement (e.g., receipts, session notes, diagnosis codes).
9. What is the reimbursement timeline for out-of-network services?
- Get an idea of how long it will take to get reimbursed for out-of-network therapy sessions.
10. Are there any network exceptions or special provisions for out-of-network mental health services?
- Some insurance companies have exceptions for certain conditions or treatments, so it’s worth asking if there’s anything specific that could apply to your situation.
11. Does my plan require me to meet any conditions or provide additional paperwork for out-of-network providers?
- Some plans require extra documentation from therapists, such as treatment plans, progress notes, or additional clinical information.
A Parent Friendly Guide How to Submit Insurance Super Bills:
- Call insurance and confirm out-of-network OT and/or Speech Therapy benefits.
- Attend therapy and pay for services.
- Depending on preference, receive weekly or monthly superbills from Irvine Therapy Services.
- Log in to your insurance website.
- Upload superbill (PDF) under “Submit a Claim.”
- Wait for reimbursement check or direct deposit.
- Save all documents for your records.
