Medical Assistance (M.A.) will cover in-network benefits for COLLAGE-enrolled individuals with certain diagnoses. To begin application for M.A. benefits, please call 1-800-692-7462, then 215-560-2547. Once you are enrolled with M.A., you can then apply to receive payment for COLLAGE via the Medical Assistance Behavioral Health insurance company that covers the county where you live:

• Delaware and Montgomery Counties - Magellan
• Chester County - Community Care Behavioral Health
• Philadelphia County - Community Behavioral Health

If your child has Medical Assistance, we will need the following documents to get COLLAGE services paid for:

• Copy of your primary insurance card - front and back
• Copy of M.A. card - front and back
• Prescription from a medical doctor
• A Psychological Evaluation Report less than a year old with diagnoses listed in DSM format (5 axes of diagnosis)
• The diagnoses will look like the list below and the report must contain the signature of the examiner:

• Axis I
• Axis II
• Axis III
• Axis IV
• Axis V       GAF

The Psychological Evaluation Report can be obtained from your psychologist, psychiatrist or some referring physicians. IEPs and other school-generated reports are not acceptable as assessments for insurance authorization.

Prescriptions (script/order) from a physician should state the following:

40 group occupational therapy visits* with diagnosis and diagnosis code
*(40 visits are equivalent to one year of services. This is not a required length of therapy, but will reduce the inconvenience of repeated requests for a new prescription.)

If the physician has questions about this or about the COLLAGE program, ask the physician to call our office.

Other special considerations about M.A. Insurance Coverage:

Please call the office before any future series you might attend, to verify your insurance eligibility, and to discuss whether further insurance steps need to be taken.

Be sure to notify our office immediately of any change that occurs in your insurance carrier or your particular insurance plan. Otherwise, there may be a lapse in your coverage.

If your child does not have Medical Assistance, you may be able to use your primary (commercial) insurance for payment. COLLAGE now accepts some commercial insurance (Aetna, Independence Blue Cross, Highmark, United Healthcare). Call your insurance company and ask if they cover Group Occupational Therapy.

Ask if your policy has a copay and/or needs a referral. You are responsible for obtaining this information and supplying it to COLLAGE prior to receiving services. Insurance denials for lack of referral or authorization are your responsibility. Give COLLAGE a copy of your card, front and back, and COLLAGE will bill the insurance company for you. You will then be responsible for payment of anything not covered by your insurance.

If COLLAGE does not accept your primary insurance you can pay out of pocket. The cost is $80 per each 1.5 hour session. COLLAGE can provide you with a receipt if you wish to seek reimbursement on your own. COLLAGE also now takes credit cards.

If you need to receive a statement to attach to your Insurance Company's claim form, ask us for an “Insurance Statement.” It will be issued AFTER a series ends (or after other service takes place) only if it has been requested and if payment for the service has been received by COLLAGE.

• It will identify relevant dates, codes, and names of therapists, etc.
• It will be given after the service has been provided because insurance companies usually will not pay for dates that have not occurred yet or have not occurred at all.
• If a person was absent, that date will not appear on the Insurance Statement because insurance companies usually will not pay for those dates. Therefore, the amount of reimbursement would be less than if the enrolled person had attended all the dates that the family paid for.

If you need to receive a “Receipt,” on the other hand, it can be given to you any time after payment is received and it will list the period of service, not specific dates. It will not have all the information that medical insurance companies require but the receipt may be used when calculating Income Tax (consult your tax advisor) or you may be able to use a receipt for a Flexible Spending Account or Health Savings Account at your place of business.

Please remember that it is necessary to ask us for an Insurance Statement or a Receipt the first time you need one. Thereafter it should be sent to you from the office automatically.

Rationale regarding out of pocket fees and receipts: Fees for COLLAGE sessions are based on an educational model of “tuition”-type payment in advance so:

• We can determine the makeup of each group, since every member added or subtracted changes the social makeup for the remaining members.
• We can decide when we need to turn away very suitable applicants because of full groups or because of particular other members within a group.
• We can assign therapy personnel required for each group.

As with other tuitions, reimbursement cannot be made for absences. However, insurance companies always reimburse on the medical model of payment after service has been provided. Therefore, they do not pay for sessions missed by their patient for any reason. Yet we cannot provide “makeup” sessions. Each series of sessions is with a different group of people – some new to the program, some old, some new to this group but not new to the program. The social mix is different. A cancellation fee of $35 will be charged if COLLAGE is not given 24 hours notice in advance of absence. This fee only applies to people utilizing insurance for payment (both commercial insurance and MA).

If we should receive payment from an insurance company for a bill previously paid by an enrolled family, we will reimburse the family up to the amount of the insurance payment, excluding any early withdrawal fee. If you have questions about insurance coverage, please call our office at 610-356-7355.

Call the COLLAGE main number at 610-356-7355 and select the menu option for registration. Provide us with your contact information and we will send you the necessary forms to get started.

Once the forms have been completed and returned, we will schedule an evaluation.
The cost of an initial evaluation is $80 and is not covered by any insurance including Medical Assistance.

Once the evaluation is completed, recommendation for group placement will be made. Group placement is based on age and level of ability, not on diagnosis.

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