Insurance Info & Prices

Where do we provide services?

We have a data base of therapists in the Counties of San Francisco, San Mateo, Santa Clara, and Santa Cruz and beyond.  We can provide therapists anywhere in California if you can recommend a therapist.

Will insurance pay for it? And who bills insurance?

We bill all insurance but we are not IN network except Medicare.  We are a Medicare Out-Patient Part B provider, and provide that therapy at your home. (A unique service: outpatient therapy at your home.  We are not Home Health). If you have the OT, PT or ST benefit in your insurance plan the insurance will pay (we can help you find out).  Kaiser covers our services if they OK it first, at this time.

Medicare coverage has become confusing with Medicare advantage, HMOs, PPO, etc.  Call us to help determine if your services will be covered.

IN NETWORK and even HOME HEALTH criteria can be met and paid for in certain circumstances, but your insurance company must first agree to put Therapy In Your Home IN NETWORK for your specific case. Please call Therapy In Your Home for information.

What information do I need from my insurance?

• what is the coverage for OT, PT or ST for Outpatient, not home health (despite our name)
• what your copay
• what criteria you need to qualify, do you need pre-auth?
• how many visits you are eligible for, over what time frame
• your deductible for the year
• where to send the bill

The therapist can bill the insurance, or provide you with the information to bill the insurance yourself.

Long Term Care insurance covers our services depending on your policy. Always ask!

Rates are comparable to out patient therapy.

Who do I pay? How much?

Talk to your therapist about the billing.  Usually you will be sent a monthly bill.  Your EOB will show the visit dates.  Rates are comparable to an outpatient clinic.  When the therapist is out of network the insurance may send the check to you and the therapist will bill you. In some instances you may request a special service that is not paid by the insurance, in which case the therapist would bill you directly for instance for a missed visit or extra communication.

Is it covered by Medicare?

Yes, if you have straight Medicare or a Medicare PPO the service is covered.  Most therapists can bill Medicare but not all.  Call us so we can help you determine coverage.  When people call us and if they qualify, we direct them to a Home Health Agency where the visit will be covered 100% by Medicare. (Do I qualify for Home Health?)  We are an Out Patient Mobile Clinic, using your Medicare Part B.  There is a 20% copay for out patient therapy under Medicare.  Home Health does not have that copay.

When are services not covered?

A problem area with our service is that if you have HOME HEALTH nurses or therapists, our services will not be covered.  Be sure to tell us if you have a Home Health Agency involved or if one starts while we are seeing you.  You will be charged for the visits if our visits overlap with Home Health.

Also, our therapists leave a space open to see you.  If you do not cancel within 24 hours, your therapist might have a policy to charge for 1/2 a visit.  Medicare or your insurance does not cover that cost.  You will be billed privately.

How many visits will it take?

Every case is different. We give each of our clients a unique therapy plan tailored to their individual needs. Our average is 8-16 visits, many people only need 1-3 and we have about 50% of our clients who either use our services ongoing, or on-call.

How long is a visit?

A visit is generally a bit less than an hour.  But we can be flexible, it depends on the needs of the client and who is paying the bill.

Do I need a prescription?

Please ask your physician to send us a prescription and a list of ICD-10 codes (Diagnosis codes) and any helpful information.  Your doctor can fax to a secure fax # 877-334-0714.  We can also request this information from the MD ourselves. If for some reason you do not want to go through your MD, please call us about this situation.  We are able to provide some visits without a prescription, but prefer to work under an MD order.

What are my other options?

You can participate in out-patient therapy at a clinic; however, our in home therapy services are economically competitive with out-patient therapy, and it is provided in the comfort of your own home.  On the other hand you don’t get the satisfaction of going out and being with people.  You decide based on your specific needs.  There is equipment in a clinic (for kids and people with orthopedic needs, especially) that might make a clinic more appropriate.

There are community based programs, also, especially for specific diagnoses and problem areas.  See the resource section of this website.

Can you do outpatient therapy at the office?

We do not practice therapy in our office. If you have a place other than your home where you would prefer to participate in therapy, please let us know.