We get it: Insurance can be complicated. Filing claims, following up with health care providers and your health plan, figuring out what’s in and out of network, and staying on top of reimbursements can take up a lot of time—something we know that parents just don’t have a lot of.

When it comes to intervention therapy services like those offered by Village—occupational therapy, physical therapy, and speech therapy—providers may be in network (with coverage at a contracted rate with your plan) or out of network (where the option is cash pay in full). 

With out-of-network providers, you may be able to get some amount of reimbursement from your health plan, but you’ll have to know the terms of your coverage and the steps to take to file claims.

At Village, we’ve made things easier for you. Below are a few resources to help you navigate health plan reimbursement for your child’s out-of-network intervention therapy services. 

Here, you can learn:

• What it means for your child’s provider to be in or out of network

• What to expect before starting with an out-of-network provider

• How to file out-of-network claims 

• When and how to file a health plan appeal if needed

What It Means to be In and Out of Network

One of the first steps to getting started with any new provider is figuring out if they’re in network or out of network according to your health plan. This guide can help you learn the ins and outs of in-network and out-of-network providers and what each status means for you and your child when looking for providers.

What to Know Before Your Child Starts a New Service With an Out-of-Network Provider

You found the perfect provider for your child, and they’re out of network. Now what? This guide can help you understand what seeing an out-of-network provider means and exactly what questions you should ask your health plan before getting started.

Smarter Filing for Out-of-Network Claims

Seeing an out-of-network provider also means having to file out-of-network claims. This guide can help you learn how to correctly file a claim and avoid some of the most common reasons why claims get denied.

When and How to File a Health Plan Appeal

If your health plan decides to deny a claim, you can choose to file an appeal. This guide can help you learn how to properly file a health plan appeal first at the health plan level and, if needed, at a higher level of appeal with the appropriate third-party external review agency. 

How Village can help

Child-centered care is at the heart of what we do. When you partner with Village, you’ll get connected with our network of vetted pediatric therapists (OTs, PTs, and SLPs) so that you can build the care team your child needs. Our pediatric therapists may be in network or accept cash-pay options, and we offer a benefits checker to help you understand coverage. 

Many of our families are able to find more affordable options using Village, with rates that are up to 75% lower than traditional services at a clinic.

If you’re interested in getting started with Village, you can book a free consultation to learn more about our HIPAA-compliant platform and how we can lead you and your family through finding skilled pediatric providers who can help your child thrive. 

Whether you’re looking for in-home or virtual sessions, or an in-network or cash-pay provider, we have a large network of therapists here to guide you every step of the way.