Insurance

At Theraplay we do our best to make sure our patients are well covered. We are constantly growing our insurance base, so we can help every family in need of pediatric therapy services. We currently in-network for the insurance companies listed below.

  • NC Medicaid
  • UHC
  • Tricare
  • Carolina Complete Health (Medicaid Managed Care Plan)
  • UHC Community Health Plan (Medicaid Managed Care Plan)
  • NC Healthy Blue (Medicaid Managed Care Plan)

You may also elect to user our private pay option please call our office at 919-774-1281 for more information regarding our rates.

If you have any questions about your possible coverage, don’t hesitate to reach out to our staff with any questions. We are happy to help in every way we can, and proud to represent clients throughout the Sanford and surrounding areas. To learn about other patient resources we offer click here. For more information, contact us today through our online contact form, or reach out through our information found on our contact page.

Out of Network Benefits and Private Pay information:

You may be able to request a network gap exception (also called Single Case Agreements and Network Deficiency Coverage). It is a tool health insurance companies use to compensate for gaps in their networks of contracted healthcare providers.

When an insurer grants a network gap exception, the exception usually only covers one specific service during a limited time frame.

What you’ll need for an exception request:

  • The CPT code describing the healthcare service
  • The ICD-10 code describing the diagnosis
  • Theraplay’s contact information
  • A date range during which they expect to receive the requested service

What to do if your request is denied:
Call your health insurance company to find out why. Once you understand why the request was denied, you can either appeal the decision or submit a brand new request that includes additional information that they may be requesting.

Single case Agreements (SCA)

Some insurance carriers do not offer network gap exception policies and may instead call them SCAs. A Single Case Agreement (SCA) is a contract between an insurance company and an our office as an out-of-network provider for a specific client, so that the client can see our office using their in-network benefits (i.e.. The client will only have to pay their routine in-network co-pays for sessions after meeting their in-network deductible).

Flexible Spending Accounts and Health Savings Account

Occupational and speech therapy services are eligible for reimbursement from flexible savings accounts (FSA), health savings accounts (HSA), health reimbursement accounts (HRA), dependent care flexible spending accounts (DCFSA) and limited care flexible spending accounts (LCFSA).