INSURANCE AND BILLING INFORMATION
Navigating Insurance Information
Understanding benefits and insurance requirements can be difficult and at Cornerstone we will try and assist you with this process. Every insurance company and individual plans have different benefits and we ask that prior to services, our parents take time to understand their coverage and what that means for their child's therapy services.
Cornerstone Therapies is a Provider for:
Aetna/Aetna Assured Health
Affiliated Doctors of Orange (ADOC)
American Specialty Health (ASH)
Blue Shield of CA PPO/EPO
Care Centrix National Claims
CA Foundation for Medical Care
Cal Optima Direct
Choc HeatlhCare Alliance- Cal Optima
Delta health Systems
Family Choice Network
Health Care Partners
Hoag Hospital Affiliated Physicians
Manage Care System
Memorial Care Medical Group- IPA
Motion Pictures Industry
Operating Engineers Local
Pinnacle Claims Management
Regal Medical Group
Screen Actor Writers Guild
St Joseph’s Hospital Affiliated Physicians
St Joseph’s Heritage
St Jude’s Heritage
Talbert Healthcare Partners Medical
United Healthcare/UHC Choice +
United Health Care Military
UCI Affiliated Physicians
As healthcare providers, and as a courtesy to our patients we are willing to call and obtain an explanation of your benefits as it relates to the services obtained through our facility. We are given information from your insurance company, but please be advised that the benefits quoted it is not a guarantee of payment. Since you are ultimately responsible for knowing your benefits and your cost responsibilities, it highly recommended that you also check with your insurance company regarding your cost share for the services you are pursuing. Your insurance is a contract between you, your employer, and the insurance company. We are willing to bill the insurance on your behalf, but we are obligated to charge the copayments, coinsurance, and deductibles that are associated with your plan and indicated on your explanations of benefits. Most insurance companies have an online service where families can check services billed and payments rendered. We recommend that families continue to check their insurance claims to ensure your insurance company is continuing to pay for benefits. Any services not paid by insurance will be the financial responsibility of the patient; patients that are not covered for services through their medical insurance, can opt to pay on a cash basis.
FREQUENTLY ASKED QUESTIONS
DO I NEED TO HAVE AN EVALUATION TO START THERAPY?
Yes, you need to have an evaluation to start therapy, however, if you have a current evaluation from another facility, your insurance company may accept the changing of the place of therapy without requiring another evaluation. However, you will need a new evaluation if you change insurance companies.
DO I NEED TO HAVE A PRESCRIPTION TO START THERAPY?
Most insurance companies require a referral, prescription or confirmation of a diagnosis to authorize an evaluation for services. We advise our patients to obtain one from a specialist (e.g. developmental specialist, neurologist) or their primary care physician. For ABA services, most insurance companies require a diagnosis dated within 2-years of the start of the evaluation.
IN CALIFORNIA ARE ALL INSURANCE PLANS REQUIRED TO PAY FOR SERVICES FOR AN INDIVIDUAL WITH AUTISM?
Fully funded insurance plans generally are obligated to pay for services for autism, but self-funded plans operate under different guidelines and may not cover services for that diagnosis. Each insurance company and plan will have different benefit options for their members. It is best to check with your individual plan prior to the start of services.
HOW DO I SCHEDULE AN APPOINTMENT TO RECEIVE SERVICES THROUGH MY INSURANCE?
If you have an HMO, you must get a referral from you PCP, however, if you have a PPO you will need to fill out paperwork, so that our staff can call and verify benefits and then set up the evaluation.
HOW LONG DOES IT TAKE TO HEAR BACK REGARDING SERVICES REQUESTED FROM AN EVALUATION?
Generally, the insurance company may take up to 30 days to process a claim. You can check online with your insurance company to monitor the progression.
DO YOU ACCEPT AND BILL INSURANCE?
At Cornerstone we accept a number of insurance plans and can assist you with confirming your benefits prior to receiving services. We ask that all parents read and understand their individual plan benefits as they may differ across members and plans.
For questions regarding billing and insurance information contact our billing department.