The Carruth Center does not guarantee coverage and/or the ability to gain coverage of services. We are a fee-for-service facility and families are responsible for all payments. As a fee-for-service facility, we are considered out-of-network, and therefore, ask that families act as the liaison for any direct communication with their insurance companies to determine coverage.
The Carruth Center provides clients with invoices/services provided forms that include necessary codes, and clinician and facility information for convenience and ease of filing claims.
The Carruth Center cannot accept payment from insurance companies. This creates an accounting error as it would reflect double payment. All checks issued to Carruth are returned to the insurance company with a request to issue payment to the family. We will notify the families when this occurs.
Determining your coverage
Download our guide for help in determining your level of insurance coverage: Determining Your Insurance Coverage Guide (PDF)
Request for tax support requires a 2-week notice. Please contact Lori Pohutsky, Accounting Assistant
Important Insurance Definitions
Reasonable and Customary: Most insurance payments are based upon rates that are deemed reasonable and customary for the regional/local area (often refer to the zip code of the clinic) and/or reference Medicare/Medicaid rates. It is often difficult to get insurance companies to state what this rate may be and it may change frequently.
Limitations/exclusions: Please use your online plan or human resources representative to obtain a copy of your benefits policy. Also use our "Determining your insurance coverage guide."
- Age (of Onset): Often policies may cite that they will not cover speech pathology services for “educational aged” clients – often 6+ years
- Medical Necessity: Many policies state that they do not cover developmental delays; thus, coverage is only deemed appropriate if the loss is injury, illness or loss related. If you challenge this, you must have documentation and evidence. The review will be done either by a nurse or doctor. You may request that the reviewer be from a pediatric background and you may also request the notes of the reviewer.
Explanation of Benefits (EOB): This is the form the insured party - YOU - receives denoting the determination/results of the submitted claim. Keep them organized.
Case Manager: You may request that a specific case manager (most often a registered nurse) be assigned to your child’s insurance claims. You have the right to request a manager with pediatric experience. Some companies may call them case advocates.
Appeals: You have the right to appeal a denial. The service provider (The Carruth Center) can provide support information; however, it must be bundled with your appeal or in reference to your appeal/reference number.
Claim Submissions: When filling out claims submission forms, use a fine point pen (not Sharpie). Words written in Sharpie get distorted when they are faxed. When entering the diagnostic code, be sure to use all four or five digits in the code including the zeros. Example: 299.00