� OTA Watertown Financial Policies œ

OTA is a participating provider of HPHC and Harvard Vanguard for OT, PT, and Speech therapy.   For Speech therapy only, we are a participating Blue Cross provider.  For all other insurance companies, we are an out of network provider.

Insurance Inquiry:  As a courtesy, our billing department will do an insurance inquiry at any time at your request.  We will call you with the results of the inquiry on a timely basis. 

Insurance responses: Most insurance responses are based on the information that the claim or member service person has readily available and how they interpret your policy. 

 When doing your own inquiry for insurances that we are not providers of please mention that:

OTA is a non-participating facility

We are not affiliated with a medical/hospital facility

We do not do rehabilitation for injuries

We are a private occupational, speech and physical therapy facility. 

You may have benefits for an out-of-network provider or belong to a POS/PPO plan that covers outside facilities.  However, OTA will often not be covered by these insurance companies due to the fact that we are not hospital affiliated and a private facility. 

 If your insurance has told you they will pay for our services, OTA will provide you with appropriate statements that you may use to seek reimbursement.  If your insurance company has declined payment, we suggest that you still initiate sending a bill to your insurance company since sometimes they will pay the benefit despite the denial.  OTA does not bill insurance companies except for Harvard Community Health Plan (and Blue Cross/ Blue Shield for speech only). 

Common Questions:

1.  Do we need a referral from our physician to come to OTA for services?

OTA does not require you to have a medical doctor refer you for services, but if you want services billed to an insurance company, it is necessary that you get one.  Most clients find it helpful to have a medical referral on record so it is there if needed.

Insurance companies differ regarding the need to obtain preauthorization for services, the number of visits they will cover in a given time period, and whether they require periodic re-evaluations.  The client/parent is responsible for keeping track of these requirements.  While OTA can help you make insurance inquiries, we are not responsible for keeping track of this information.  For clients covered by HCHP/Harvard Vanguard, OTA will obtain the prior authorization for treatments.  Clients need to provide us with a letter of medical necessity from their primary care physician.

2.  When do I need to pay if you are also billing my insurance?

If OTA is a participating provider of your insurance company (HCHP/Harvard Vanguard; and for speech therapy only, Blue Cross), you are required to pay your co-payment amount at the time of service.

All other clients receive services through OTA’s Comprehensive Treatment Plan.  Under the terms of this plan, each month of service is prepaid (or the entire course of treatment may be prepaid).  You may submit the paid invoices directly to your insurance company.

3.  Will you bill my insurance company automatically?

No, but we are happy to provide you with an invoice that you may use to submit to your insurance for reimbursement.

4.  My insurance company said that you cannot bill me for your services directly.

This is only true if we are a provider for your insurance company.  Our fee agreements state that you are responsible for payment of your bill for services rendered.  If your insurance company does not hold a contract with OTA then you are the only responsible party for payment of your bill.