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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, please contact our Billing Coordinator to set up the billing process (617-923-4410 x103). 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 will provide you the courtesy of billing your insurance company, but please understand that in most instances we are not providers and cannot make any demands on payment issues with your insurance company.
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.
Most 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, or OTA will submit the claim on your behalf as a courtesy.
3. Will you bill my insurance company automatically?
No, but we are happy to bill your insurance company if you specifically request it of the Billing Coordinator and supply us with all necessary insurance information.
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.
5. My insurance company said that they would pay. Can they pay you directly and I only pay the copay/coinsurance?
Unfortunately, due to nonpayment from a number of insurance companies we are unable to wait for your insurance payments. We will bill both you and your insurance company at the end of each month and give you a refund for any insurance payments we receive. Or we can give you monthly invoices for you to submit to your insurance company on your own as long as you have paid your balance in full. If your insurance company agrees to pay an OTA claim, you will usually receive an EOB form stating this approximately 2 weeks before OTA receives payment. Most insurance companies take at least 60 days to pay our claims. We appreciate your understanding.
6. Are there any reduced rates?
We do not have any reduced rates for evaluations. If you have financial hardships you may ask the front desk secretary for a Personal Financial Statement that can be reviewed by the Administrative Director for consideration of a further reduction in treatment fees (not evaluation fees).
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