FINANCIAL TOOLBOX

Please refer to this document for information regarding which steps to take when you have a Financial/ Billing Question. 

                                                         Topics of Frequently Asked Questions: 

  1. Payment Collection Protocol
  2. Insurance Billing Protocol 
  3. Meeting your Deductible or Out-Of-Pocket Maximum
  4. Monthly Statements 
  5. Claims Processing 
  6. Benefits Verification 
  7. Change in Insurance Policy 
  1. Patient Payment Collection Protocol
  2. All copays, coinsurances, and patient financial responsibilities for outpatient services are due at time of service. We are not able to set up weekly, bi-weekly, or monthly payment collections at this time.  
  3. All copays, coinsurances, and patient financial responsibilities for ABA services done in the preschool are due every Monday. 
  4. We collect your financial responsibility based on the benefits quoted from your insurance company. We cannot wait for your claim to processes in order to collect your financial responsibility.  
  5. If your child is seen for a large volume of therapies or in a location where we do not have a receptionist to collect payments, we encourage that families put a credit card on file.  
  6. If we are not informed of a deductible/out-of-pocket max being met in a timely manner, it may result in a credit on your account. Credits will be used towards future balances. 
  7. If you have any questions about payment collections or if you noticed that a credit is due, please fill out the Financial Inquiry Form so we can see what we can do to help.
  • Insurance Billing Protocol
  • After your child is seen, your child’s therapists enters the visit with a billing code in our EMR system. 
  • 48 hours after the visit occurs, our third-party billing company submits the visit to the insurance company in the form of a claim.
  • It takes up to 60 days for the insurance company to process the claim and send the Explanation of Benefits (EOB) to us with either a payment or a denial. 
  • Our third-party billing company posts the insurance payment into our EMR system as processed by your insurance company. 
  • If you find that a visit was billed incorrectly or in error, please fill out the Financial Inquiry Form to inform us so that we can resolve it. Please be sure to include the date of service in question.
  • Meeting your Deductible/Out-Of-Pocket Max :
  • We are instructed via an insurance EOB when you meet your deductible or your out-of-pocket maximum (OOPM).  
  • While waiting for the claims to process, we must charge what the insurance benefits were quoted as at time of verification. 
  • Due to HIPPA reasons, your insurance company will not inform a provider when you have met it your deductible or OOPM.
  • If you have been notified by your insurance company that you have reached your deductible or OOPM before we have received that information, please fill out the Financial Inquiry Form and include the date it was met and the reference # from the phone call with your insurance company.
  • Monthly Statements
  • For your convenience, we mail statements on the first of every month. They will only generate if there is a balance due on your account.  
  • Balances can occur on statements if there is a fluctuation in services rendered, if payment was not able to be obtained at time of service, if there is an established payment arrangement, or if insurance benefits differ from what was initially quoted.
  • If you have placed a credit card on file, we will call you for permission to run it at that time.
  • Past due payments are due by the 15thof that month. We apply a 5% late fee if payment is not received by that date.  
  • If your account balance exceeds our acceptable threshold, we will put your child’s treatment on hold until the balance is collected. 
  • If outstanding balances are more than 90 days old without a payment arrangement made, we will send the overdue account to our Collections Agency.  
  • If you have questions about a statement you have received or if you would like to request other types of statements, please fill out the Financial Inquiry Form with supporting documentation so we can resolve it.
  • Claims Processing
  • If you find that a claim has processed incorrectly or that it does not reflect the benefits quoted, please call your insurance company for details. 
  • If it was your insurance company that made the error, we ask that you help us by calling the member services phone number on the back of your insurance card and ask them to reprocess the claim to fix the error. Please then provide us with the reference # from your call. 
  • If you find that Great Strides has made the error, please fill out the Financial Inquiry Form with the reference # from your call with your insurance company and then we will correct the claim.   
  • Benefits Verification  
  • As a courtesy, Great Strides will call your insurance company to obtain your coverage for services requested and then call you to go over it before we schedule your first appointment.
  • We occasionally are quoted incorrect benefits from insurance companies and kindly ask that you also call your insurance company to ensure we have the same information. 
  • It is your responsibility to understand your insurance coverage and benefits for services requested. 
  • If you receive a different benefit quote than we do, we may ask to do a 3-way call with you and your insurance company so that we can settle the discrepancy. 
  • Please call our Patient Account Specialist at (904)886-3228, extension 307, with any questions about your benefits. 
  • Change in Insurance Policy
  • We ask that if you change your insurance policy for any reason, please notify us as soon as possible. 
  • Please fill out the Financial Inquiry Form to notify us of the new policy, the effective date, and a picture of the front and back of the new insurance card. 
  • If you do not have the new insurance card yet, please call your insurance company and obtain the new member ID # in the meantime. 

Financial Inquiry Form link: 

Please submit this completed form to our Patient Account Specialist for resolutions. If you need any additional assistance, please call (904)886-3228, extension 307.

Commonly Used Insurance Terminology:

Deductible:The amount of money (defined by your insurance plan) that needs to be met before your insurance benefits kick in/begin. You will be responsible for 100% of the treatment rendered until the deductible is met. 

Co-Pay:A set dollar amount (defined by your insurance plan) that is owed per day/per treatment regardless of how many hours are rendered.

Co-Insurance: A set percentage (defined by your insurance plan) that is owed per hour of treatment rendered.

Out-Of-Pocket Maximum (OOPM):The amount of money (defined by your insurance plan) that caps your financial responsibility. Once you meet your OOPM, your insurance company is responsible for 100% of the treatment rendered.

Explanation of Benefits (EOB):A document that is sent by your insurance company defining the amount paid/denied for each visit/claim submitted. This document allows us to… 

1. Determine if deductibles have been met because that would mean insurance started paying. 2. Determine what copay/coinsurance your insurance company is leaving the patient responsible for. 

3. Determine if out-of-pocket maximums have been met because that would mean insurance paid the whole amount and left no patient responsibility. 

Mental Health Benefits:This department of benefits (defined by the insurance companies) is specifically for mental illnesses, cognitive conditions, & ABA services. 

Medical Benefits:This department of benefits (defined by the insurance companies) is for all other physical services like Occupational Therapy, Physical Therapy, and Speech Therapy. 

We are currently not accepting any job shadowing positions until further notice. Thank you for your patience.