How the fee system in BCW works
Many insurance companies do not cover developmental issues or delays without a significant congenital condition or diagnosis. If claims are denied by your insurance, you would owe whatever fee BCW assessed to you (the cost percentage you were assessed at the intake process by the service coordinator- it might be 100%, might be 35%, 12% etc since BCW works on a sliding scale) and that % will be taken from the full rate per session which is the medicaid rate for the service you are receiving.
However, if therapy is covered under your plan, BCW pays all deductible, coinsurances, and copays for services that are processed as “covered” by insurance. So, for a covered service, there will not be a fee while your child is in the babies can’t wait program.
Even though private agencies are not in network for all insurance companies, as long as you do have out of network coverage too, BCW will pay for those covered sessions with no fee to you even if insurance pays nothing or very little of the fee over the course of the year.
Adding Sessions privately through insurance filing or private pay:
This could be an extra weekly session or a different therapy service or continued services after your child has aged out of babies can’t wait.
Yes, we can do this! Please email [email protected] to check benefits for this.
A note about private insurance policies
Sometimes they do not issue a denial until an actual fee needs to be paid, which means they often apply fees to your out of network deductible until that is met. Other times they report the service to us as covered and then months later conduct a medical “review” in which they decide the service is not medically necessary. So we never know until the statements actually come in (sometimes two months later) if you will have fees or not. Please count on having the fee per session you were assessed by the Babies Can’t Wait program.
Checking benefits is not a guarantee of payment - ever!
Every customer service representative that we talk to always repeats this to us many times.
Lastly, although we are in network with some private insurance companies, places like CHOA are in network all private insurances. You always need to consider that you will not have the babies can’t wait coverage for deductible fees and coinsurances there.
In-network services are often not less expensive than the sliding scale and deductible and copay coverage offered by Babies Can’t Wait.
Finally, your Insurance company does not bill you, healthcare providers do (us)
So, if you receive statements in the mail from them, sometimes with threatening messages saying “because you chose an out of network provider your fee owed will be 220.00 etc etc” . Or, “Patient balance is ___,” or “Patient owes___”, ignore them. This is not a bill.
These statements from your insurance companies have nothing to do with our program in conjunction with Babies Can’t Wait.
You do not owe the Patient Balance as stated by your insurance company, and those statements are not a bill. We will send you our invoice by email with explanation of any fees that are due, and that will be your percentage of the medicaid rate as stated above, and only if your insurance company has denied the claims.
Please note that we can’t create your invoice and begin notifying you of any fees until your insurance company has processed the first claims. This can take up to two months although we begin filing immediately after you start. Feel free to call us with questions!