For any questions regarding billing and payments,
please contact our Billing Specialist:
Mark Rommel
E: mark@ohanacenter.com
P: 509-888-7435 ext 4
Insurance FAQs
Q: Which insurance companies does Ohana OT work with?
A: Ohana works with most private and medicaid insurances except for United Healthcare and Medicare. Ohana will contact your insurance to verify benefits prior to your initial eval and get any authorizations needed. If we are not in network with your insurance, we can work to contact your insurance to determine if we are able to provide out-of-network services, and if so, your copay/coinsurance will be based on out-of-network costs. It is always a good idea to contact your insurance in order for you to understand your benefits as well.
Q: What if Ohana is unable to work with my insurance?
A: We will do our best to work with your insurance. If it is determined that we are unable to bill your insurance, we will let you know and you will have the option of cash payments for OT services. We may ask you to contact your insurance as well.
Q: What is an ECOC?
A: An ECOC is an Estimated Cost of Care. This is a cost estimate based on your insurance benefits and the number of estimated visits for your child. This estimate factors in insurance plan deductibles, copays or coinsurance, max visits, codes billed etc… We do our very best to make estimates as accurate as possible based on benefit information we receive from your insurance, however it is an estimate of costs. In order to focus on therapy, we prioritize collecting costs up front whenever possible to keep things efficient and avoid any balances interfering with therapy.
Q: What are the different sections of the ECOC?
A: The ECOC is broken down into three main sections. If you are a new client, the first two lines will specify amounts due for the initial eval and first after visit. The middle section is calculated based on how many visits the therapist recommends after the evaluation as well as any limitations by insurance (such as max visit limits). This section will specify any deductible that applies as well as your copay or coinsurance amount. The last section is costs for the final evaluation and graduation visit. (Graduation may or may not occur in the current calendar year.) *Due to developmental testing and evaluation codes billed, costs are different for the first few and final few visits.
Q: I have a large deductible and on the ECOC each visit amount is going towards my deductible. Why is the ECOC written that way?
A: We understand you may have other medical needs throughout the year that will be applied to your deductible, however, we base the ECOC on just OT visits to Ohana. We will do our best to inform you once we notice your deductible has been met. If you suspect you may have met your deductible, please let us know and we encourage you to contact your insurance to confirm as well.
Q: I see on the ECOC a max visit limit. What does this mean?
A: Each insurance company has a set number of visits they allow, that they are willing to pay for, for their client to visit an occupational therapist, a speech therapist, and a physical therapist. That number is a combined number of visits, not the max visit per therapeutic area. If your child is currently or soon will be using either professional speech or physical therapy, please inform Ohana of this.
Q: What if we exceed the max visit limit?
A: If you have secondary insurance, Ohana will submit the claims to your secondary insurance once the primary is rejected due to the max visit limit. If you do not have secondary insurance, then there will be a direct cost out of pocket of $150.00 per visit of any visits not covered by insurance.
Q: I contacted my insurance company and they said that Ohana is in-network, but my ECOC has out-of-network benefits. What are my next steps?
A: Please contact our billing department and ask them to investigate further. Sometimes we are given conflicting information so we may need to call again to get accurate information. As always, we encourage you to contact your insurance.
Q: How can I pay for services?
A: We prioritize collecting ECOC costs up front whenever possible to keep things efficient and avoid any balances interfering with therapy. You can pay in person in the clinic, online via our patient portal or over the phone. If you do not have access to the patient portal send an email to info@ohanacenter.com requesting access. If you are paying using cash or check, please stop by the office during our regular business hours to drop off any cash or check payments.
Q: How can I use my HSA for Ohana OT services?
A: Ohana can provide you with monthly statements that you can submit to your HSA and then pay your portion to Ohana. Monthly statements will be emailed the first week of each month. If you do have a HSA and would like monthly statements, please inform our billing department.
Q: How is secondary insurance handled at Ohana?
A: Ohana first submits a claim to your primary insurance and then if there is any portion left to pay, we submit it to your secondary insurance. If your secondary insurance is medicaid, Ohana accepts what medicaid pays and does not bill the client any remainder. If the secondary insurance is private and there is a remainder after the secondary insurance pays its portion, it is the responsibility of the client to pay any remaining balance.
Q: Why does my coinsurance or copay amount change during the year?
A: Insurance companies have a tendency of making changes throughout the year. It is often at the six month period, but may occur at other times. If you have met your out-of-pocket max, you may not have to pay any copay or coinsurance for the remainder of the year. Insurance companies may also increase your coinsurance costs if the amount they pay per visit is less. We will do our best to inform you of any changes.
Q: Our child’s therapist informed us that they need to perform a re-evaluation. Is there an extra cost?
A: It depends on your child’s insurance and when during the year it occurs. If a re-evaluation occurs you can reach out to the billing department for them to find out your cost. The billing department will also attempt to communicate a cost change to you once this particular claim has been processed.
Q: Our child’s therapist informed us that they need to add additional visits. How can I find out my cost?
A: Reach out to the billing department and they will provide you a cost based on the additional number of visits.
Q: If during the year there is a change in our insurance, either primary or secondary, how do I inform Ohana?
A: Please fill out the form in the following url https://ohanaot.jotform.com/221794387073161. It is important to inform Ohana of the start and end dates or your new insurance coverage. Note: if you change primary insurance, Ohana may need to create a new ECOC. If your primary insurance has changed and you have a secondary insurance, please inform the secondary of the change and the policy start date. We also will request a copy of the new insurance card(s) (front and back).
Q: If my child graduates, and I suspect I may be getting a refund, when can I expect a refund?
A: Once all claims have been processed, your portion has been paid, and if there is left over dollar amount in your prepaid account, then Ohana will send a refund check in the mail. This can take somewhere between three to six weeks after graduation.
Q: Why have I received an emailed statement from Ohana.
A: Ohana sends out monthly statements based on 1) Claims from the previous month(s) that have been processed by your insurance and you owe a deductible/copay/coinsurance for claims. Or 2) If there is no amount left in your prepaid account to be applied to any claims.
Q: Can I pay my statement balance online?
A: Yes. In the statement email, there will be instructions and options on how you can pay, including online payments.
Q: I paid last year for a certain number of visits based on last year’s ECOC. Why am I getting a new ECOC for this year?
A: At the start of the year, everything gets reset from your insurance. If you have paid your total ECOC one year, but continue therapy spanning into a new year, your insurance will reset and new deductibles may apply and you are responsible to pay towards your deductible until it is met and any copays and coinsurance amounts. ECOCs are calculated based on the estimated number of remaining visits based on your child’s plan of care. If you have any questions about your plan of care estimates, we encourage you to check in with your child’s therapist and ask them when graduation will occur.
Q: If I paid the amount of visits last year, do I have to pay that same number this year?
A: The ECOC for each year is based on the estimated remaining amount of visits your child will need. If you paid your ECOC from the previous year and have money left over from the previous year, it will be applied to visits for the current year.
Q: How do I contact the billing department?
A: You can send an email to mark@ohanacenter.com or call our main number at 509-888-7435 ext 4. The billing department is available Monday through Thursday 8:30 AM to 5:00 PM. On Fridays it is 8:30 AM until 12:30 PM. After hours, please leave a message and we will get back to you as soon as we can. If there is no answer, please leave a message including your name, your child’s name and your phone number, and we will get back to you as soon as we can.
Q: Can I meet with the billing department face to face to discuss billing or insurance concerns?
A: The billing department works offsite, but if you would like a face to face meeting, we’d be happy to set up a video call. Just reach out to the billing department and we can arrange a call.
For any questions regarding billing and payments, please contact our Billing Specialist:
Mark Rommel
Billing Specialist
E: mark@ohanacenter.com
P: 509-888-7435 ext 4
