Insurance & Payment Policy
Sensory KIDS will bill insurance when applicable. Sensory KIDS is contracted or in-network with the following insurance providers:
- Regence BCBS
- Care Oregon
- Tri-Care West
- Moda (with plan exceptions)
Sensory KIDS is able to bill against out-of-network benefits for the following insurance providers:
- United Health Care
- Pacific Source
Responsibility of Parent/Guardian
Sensory KIDS will provide a verification of your family’s insurance eligibility and benefits before services are rendered. As this will only be an estimate of coverage, we strongly recommend families to call their insurance company with any questions. It is the family’s responsibility to fully understand their insurance plan’s coverage and limitations. Insurance companies will pay for services when a claim is received. Services can be denied at any point in therapy (despite approved authorizations) if your insurance does not believe the service is medically necessary. Families will be responsible for any service payments if coverage is ultimately denied.
Sensory KIDS is committed to providing the highest quality care at a fair and reasonable cost. For clients who choose to pay the out-of-pocket rate for our services, the following fees will apply:
- Comprehensive Evaluation and Parent Meeting – $500
- OT Session – $165
- Additional Parent Meeting – $165
Please contact our office for further details regarding service costs. All private payments and copays will be collected at the time of service. Discounts are available depending on the method of payment. Sensory KIDS will accept payment by cash, credit/debit card, and check. All checks should be made payable to Sensory KIDS, LLC.
The following fees are not covered by insurance:
- $25 Travel fee for home or school visits
- $50 One-time fee for feeding sessions
- $88 No Show fee
- $50 Late Cancellation fee
- $33 Phone or email consultation (over 15 minutes)
- $90 fee for Full Report Write-Up
- $25 Late Pickup fee (for every 10 minutes)
Network Gap Exceptions
Network Gap Exceptions can be advantageous for families depending on their insurance policy. Network Gap Exceptions allow families to utilize their in-network benefits when seeing an out-of-network provider, and often result in a lower deductible and higher coverage percentage. If your family’s insurance plan is out-of-network, Sensory KIDS may be able to obtain a Network Gap Exception on your behalf when one or more the following applies:
- The care you are requesting is a covered benefit and is medically necessary
- There are no in-network providers in your immediate area
- Your insurance plan only allows for in-network coverage of the service you are seeking
- You believe your in-network provider cannot provide as effective treatment
As a courtesy to our families, Sensory KIDS will complete a pre-determination of benefits that will provide an estimate of in-network coverage. Please note that all Network Gap Exceptions only cover one service during a limited time frame. If families require additional time to complete therapy, there may be opportunity to request a date extension. Services are subject to the terms and agreement of your insurance plan at the time services are rendered.
Please notify us 24 hours in advance if you need to cancel your appointment. There will be no charge for sessions canceled at least 24 hours in advance. For sessions canceled with less than 24-hour notice, a cancellation fee will be charged. A failure to attend three consecutive sessions may result in termination of services. Missed appointments and late cancellations are costly for us and greatly affect the outcome of therapy. Click here to view our cancellation policy.
In the event of inclement weather, it is the client’s responsibility to call the clinic to determine if we are closed, or if opening is delayed. A $50 late cancellation fee will be charged for missed appointments with less than 24 hours’ notice. Please note that Sensory KIDS does NOT follow the Portland Public Schools closures. There will be no charge if the clinic is closed.
Federal regulations require that health care providers describe for clients the circumstances in which therapy and medical information may be used and disclosed, and how you can access this information.