We are here to help you navigate through the world of insurance terms. 

Verification of Benefits: Checking the status of a given patient's insurance coverage as well as verifying their eligibility for having a given service covered.

Explanation of Benefits (EOB) : You may receive an EOB from your health plan after your visit with the provider. It will show you the total charges for your visit and how much you and your health plan owe. An EOB is NOT A BILL. You can also use it to track how you and your family use your coverage.

Copay: A flat rate fee that you pay toward speech therapy services or other medical care. 

Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.

Coinsurance: The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

Out of pocket maximum: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits. The out-of-pocket limit doesn't include: Your monthly. premiums.

Visit limit: The maximum number of visits your insurance benefits will cover. 

Prior Authorization (PA): Pre approval from your insurance company that requires medical review. Simplicity will apply for prior authorization on your behalf if your insurance requires it. 

In network means that SPT has an active contract with your insurance company to provide services at the in network benefit level. 

Out of network means SPT does not have a contract with your insurance company which means your rate may be slightly higher. 

No. Some insurance plans have exclusions for speech therapy and specific diagnoses. We will verify your benefits on your behalf in order to see if there are any exclusions on your plan. 

If you choose to use your health insurance, benefits, rates are subject to fluctuation at the discussion of the insurance company. Rate changes are not controlled by Simplicity Pediatric Therapy and cannot be guaranteed, although we do our best to notify you if your insurance company is changing rates. 

We are currently in network with Blue Cross & Blue Shield plans, Aetna, Amerigroup, Caresource, Straight Medicaid, Katie Beckett Deeming Waiver,  and Tricare. 

We accept HSA, debit, credit, and cash payments.

Please email Katelyn Martino at katelyn@simplicityga.com. Refunds and credits will be applied to your account or an invoice for remaining balance will be sent in order to appropriately balance bills if necessary. We take your payments very seriously and handle these items professionally and promptly.