FAQs

Little B Therapy is an Out of Network (OON) provider, which means that we have no contract with any insurance company. We have chosen this model of care to allow families and our PT to determine what each individual child needs for maximum benefit without being limited by insurance and medical models. 

You may be able to receive reimbursement from your insurance company for out-of-network providers. However, please check with your insurance provider regarding your specific plan benefits, as there is no guarantee of reimbursement. This is the responsibility of the family to arrange this with your insurance provider. We can provide you with a “superbill”, which includes diagnostic and procedure codes that can be submitted to your insurance company. We ask that families act as the liaison for any direct communication with their insurance companies.

There are a few common things that many families do not realize regarding their insurance when deciding on in-network and out-of-network therapy options:

• You will have to pay out-of-pocket for services until you meet your deductible even if you see an in-network therapist.
• If the deductible is high (as many are these days) you may even be discharged from therapy before your deductible is ever met and your insurance begins covering services.
• Even after a deductible is met, the family is still responsible for coinsurance (most often 20-30% of the total cost).

It is important to understand your policy to make an informed decision about where to receive care. Our rates are below the standard cost of services in our area. 

If you are in need of in-network services there are options available to you! 

Occasionally wait times for early intervention (Babies Can’t Wait) and clinics that take insurance in the metro Atlanta area can be long.

• We are happy to see your child until they are able to get on the schedule of a qualified provider that is covered under your policy. 
• Early intervention is key, and if we can get your child started while they are on waitlists, we can easily facilitate a transition to an in-network therapist when a slot opens up. They will likely not have to undergo an additional evaluation at their new facility but this is up to their new facility policy.

Using your out of network benefits is often easier than you may realize!

This guide will assist you as you contact your insurance company to determine their process for filing out-of-network benefits. It should also help you determine if Physical Therapy benefits are included in your policy as well as how to submit a claim for potential reimbursement for the services you have already paid for.

• Call the member services phone number on the back of your insurance card.
• Tell the customer service representative you would like information about your coverage for Physical Therapy benefits with an out-of-network provider
  • Document your conversation:
    • Name of customer service representative
    • Date of call
    • Time of call
• Have the following information ready & available in the event they need it:           
  • Insured’s Name:
  • Patient’s Name:
  • Date of Birth:
  • Insurance Member ID:
  • Policy/Group Number:
  • Provider*
  • State License*: GAPT
  • PT Certification*: #
  • NPI Number*: #

• These questions may be helpful when speaking to the customer service representative:
  • What is my coverage for Physical Therapy benefits?
  • Do I need pre-authorization for therapy? If so, how do I obtain it?
  • Can I submit a superbill?
  • What is the process for filing a claim after I have a superbill for services?
  • What additional forms do I need to submit when filing my claim?
  • Where can I find the forms on your website? Can you email me a copy?
  • Can I file my claim online or do I need to mail/fax it to you?
  • Do I need to file my claim within a certain amount of time after the date of service?
  • How long does it take to process my claim?
  • Can I appeal if a claim is denied?

Your insurance company MAY request which charge codes & diagnosis codes will be used. We are unable to provide diagnosis codes until an evaluation has been completed as these are individualized to your child. However commonly used treatment codes are below.

CPT Codes:

• Physical Therapy Evaluations: 
  • 97161: low-complexity
  • 97162: moderate-complexity
  • 97163: high-complexity
• PT Treatment codes:  
  • 97110: Therapeutic Exercise
  • 97112: Neuromuscular Re-education
  • 97530: Therapeutic Activities
  • 97140: Manual Therapy
  • 97116: Gait Training 

Submitting Claims:

Most insurance companies allow you to upload a superbill in seconds on their web portal (which Little B will provide via email 0-3 business days after your session is marked as paid).

*provider details will be provided via email upon request