Navigating insurance can be difficult. This script was created as a reference to assist you in obtaining reimbursement for Occupational Therapy services and is not a guarantee by Sprout and Thrive LLC of reimbursement to you.

Steps to Checking OON Benefits

1. Call the toll-free number on the back of your insurance card to reach the customer service line. Select the option that will allow you to speak directly with a customer service representative, not an automated line. Let the customer service representative know that you are seeing an out-of-network provider.

1. Ask the customer service representative to quote your outpatient, out-of-network occupational therapy benefits.

1. Use the following questions below to guide your conversation:

• Do I [my child] have out-of-network benefits for outpatient occuptaional therapy?

• Do I [my child] have a deductible?

  • If yes, what is it?

  • How much has already been met?

• Do I have a per calendar year plan OR a per benefit year plan?

  • If per benefit year, what are my dates of coverage?

• What percentage of coverage is my responsibility for seeing an out-of-network provider?

• Does my policy require a written referral or prescription from the primary care physician (pediatrician)?

• Does my policy require pre-authorization for outpatient occupational therapy services?

  • If yes, how do I obtain the form and where do I submit it?

• Do you require a special form to be filled out to submit a claim or will the superbill suffice?

  • If my therapist provides me with a superbill, will I be reimbursed for the partial or full amount paid?

  • If my therapist provides me with a superbill, will the amount that I paid be applied towards my [child’s] deductible?

• How do I submit claim forms for reimbursement and what is the timeframe for submitting claims?