Pricing and Investment

With private pay, services are paid for directly by the client, rather than being billed through health insurance

Client Empowerment. Private pay empowers individuals to take control of their care and invest in long-term, meaningful progress without the constraints of traditional insurance.
Personalized or client-centered Treatment. Services can focus on what matters most to you—like improving daily routines, managing stress, or enhancing quality of life—without having to fit into narrow insurance criteria.
Access & Continuity. Private pay eliminates prior authorizations, specific diagnosis requirements, a capped number of sessions, & denials. Removing these barriers allows treatment to start sooner & continue as long as it's helpful.

Private pay offers significant client benefits to treatment personalization, access, & continuity (see above for details)
As a small practice with one provider, the bureaucracy of health insurance is both challenging & burdensome. Unfortunately, we lack the time & resources to wheel & deal with private insurance companies.

It means that a provider is not contracted with an insurance provider, meaning the provider cannot bill your insurance directly for services.

It depends. Insurance providers & policies vary widely in out-of-network occupational therapy coverage.

Verify with your insurance provider what is and isn’t covered when seeing an out-of-network occupational therapist.
Request a “superbill”. This is essentially a detailed invoice describing the services you received.3) Submit your superbill to your insurance provider.4) If approved, you will be directly reimbursed by your insurance provider.

We can provide you with scripts & resources to help with the above steps, but the responsibility ultimately lies with you.

Yes. We are enrolled in Medicare but are NOT enrolled with Medicare Advantage Plans (which have their own network of providers and are run by private health insurance companies).
Once your deductible is met, Medicare Part B covers 80% of the approved amount; you are responsible for the remaining 20% unless you have supplemental insurance

‍No. Per Medicare guidelines and MN statute, you do not need a referral prior to receiving occupational therapy (OT) services.
A physician, nurse practitioner, or physician assistant does need to sign off on the OT plan of care within 30 days of the initial visit—which we will take care of.

Yes. At this time, Medicare does reimburse tele-health occupational therapy services.

There is no hard cap, but Medicare tracks your annual therapy threshold. If your costs go beyond this amount, your therapist must include documentation showing that continued services are medically necessary.

Pricing & Investment in Your Health