Insurance & Payment Options for Pediatric Speech, Occupational & Physical Therapy

1. What if my insurance isn’t in-network yet?

You may still be eligible for out-of-network coverage or can choose to pay privately until we become an in-network provider. We’ll gladly provide documentation and superbills to help you seek reimbursement.

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2. Do you offer payment plans?

Yes. If your child is receiving ongoing therapy, we can arrange monthly payment plans for any out-of-pocket costs. Please contact our office prior to your appointment to set this up.

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3. How do I find out if my insurance covers therapy?

Each plan is different. We recommend calling your insurance provider and asking about coverage for speech therapy (CPT 92507), occupational therapy (CPT 97165-97168, 97530), and physical therapy (CPT 97161-97164, 97110). Our intake team can help you with this process.

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4. What is a superbill?

A superbill is a detailed invoice that includes all the information your insurance company needs to process an out-of-network claim. You can submit it directly for potential reimbursement.

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5. What if my child misses an appointment?

We ask for at least 24 hours’ notice for cancellations. Sessions not cancelled in advance may result in a missed appointment fee, as this time is reserved specifically for your child.

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6. Do you accept Medicaid? 

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At this time, we are not in-network with Medicaid plans. However, we completely understand how important it is for families to access services, and we’re happy to talk through alternative options. Some families choose to pay privately or through a secondary commercial insurance plan if available. We can also provide a superbill if you’d like to submit for potential out-of-network reimbursement. Additionally, we’re continuing to work toward expanding our insurance partnerships in the future.

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7. My insurance card says, "Highmark Wholecare." Do you accept this insurance?

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Highmark Wholecare is Highmark’s Medicaid (Medical Assistance) plan. It’s part of Pennsylvania’s state-funded insurance system that provides health coverage for individuals and families who qualify for Medical Assistance. While it’s under the Highmark name, it operates as a Medicaid-managed care plan, which means it follows state Medicaid guidelines rather than standard commercial insurance rules.

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At this time, Clear Path Pediatric Therapy is only credentialed with commercial insurance plans (for example, Highmark PPO, United Healthcare, etc.) and not with Medicaid or Medicaid-managed plans such as Highmark Wholecare, Aetna Better Health, or UPMC for You.

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The reason is that Medicaid plans have separate contracting requirements and reimbursement structures that differ significantly from commercial insurance. Many private therapy clinics choose not to enroll with Medicaid because:

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• The administrative and billing processes are entirely separate from commercial carriers.

• Reimbursement rates through Medicaid are often well below the cost of providing high-quality, individualized therapy services.

• It limits the flexibility and service options we’re able to offer to families.

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We absolutely understand how confusing this can be, especially since it still says “Highmark” on the card, but if the card lists “Highmark Wholecare,” it falls under Medicaid and, unfortunately, we are not able to bill that plan.