INSURANCE 

 

In-Network

KID FUNdamentals Therapy Center, Inc. accepts all types of PPO insurance as a form of payment, but we have partnered “In-Network” with the following insurance companies:

• Anthem Blue Cross PPO

• Blue Cross Blue Shield PPO

• Blue Shield of California PPO

• CalOptima - CHOC Health Alliance

• CalOptima - Community Network

• Cigna PPO

• HealthPartners

• HealthSmart

• TRICARE

• United Healthcare PPO

 

If you have CalOptima: Cal-Optima is the Medi-Cal coverage exclusively for Orange County residents. Please contact your child's primary care physician to request a referral for occupational therapy with KID FUNdamentals Therapy Center (NPI# 1518529635). Once insurance approves, they will send to an authorization approval which allows us to schedule your child's initial appointment for their evaluation.  

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If you are a member of one of these above-mentioned providers, we will file the insurance claims for you.

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Out-Of-Network

We accept most PPO insurance plans as an "out-of-network" provider, including:

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• Aetna PPO

• HealthNet PPO

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Depending on your insurance plan, out-of-network benefits may be payable after your deductible is met. Some carriers will reimburse you directly, while others will reimburse the clinic. Written reports and invoices will be provided upon request of insurance company as needed.  Please contact our office for more information if your PPO insurance carrier is out-of-network with us.  

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Additional Information

It is recommended that you contact your insurance carrier prior to your child's appointment to determine coverage/benefits.  We understand that the process can be overwhelming.  Here are some suggested questions to ask your insurance:

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• What is my coverage and benefits for occupational therapy? Do I have benefits that cover an evaluation and occupational therapy services?

• Is KID FUNdamentals Therapy Center, Inc. in-network or out-of-network with my plan?

• Does my plan cover out-of-network providers? At what rate/percentage?

• Is there a limit to the number of visits covered each year?

• Is there a deductible I have to meet before coverage kicks in?

• What is my co-payment at each visit?

• Are there specific disorders covered only in my plan?  If so, what are they?

• Do I need a doctor's prescription/referral or a prior authorization to initiate occupational therapy? [Note: We will need a prescription/referral to be kept on file, as insurance companies may require proof of medical necessity and they may ask when a claim is submitted who is the referring physician and the medical reason (ICD-10 code)].