Insurance Toolkit

What You’ll Get From RISE

Before you begin, we’ll provide you with a Superbill that includes:
- Your child’s diagnosis code(s) (ICD-10)
- Procedure codes (CPT)
- Dates of service
- Billed amount per session and overall total
- Our tax ID and NPI (National Provider Identifier)

Step-by-Step Guide: How to Submit Your RISE Superbill

#1. Call Your Insurance Provider

Before submitting anything, call your insurance company to confirm:
- If out-of-network therapy services are covered
- Whether pre-authorization is required
- Where and how to submit a Superbill

Use our phone script below to help guide the call.

Phone Script: Talking to Insurance
"Hi, I’m calling to ask about out-of-network benefits for my child’s occupational and physical therapy. We’ll be attending an intensive therapy program called RISE Pediatric Intensive Therapy in New Jersey. They’ll be providing us with a Superbill, and I’d like to know what steps I need to take to submit for reimbursement."

If needed, follow up with:
"Can you confirm if you require pre-authorization for out-of-network therapy?"  
"Do I need a referral from our pediatrician?"  
"What address or portal should I use to submit the Superbill?"  
"Is there a specific claim form I should attach with the Superbill?"

Take notes during the call—names, dates, and reference numbers matter.

2. Get a Referral or Letter of Medical Necessity (If Needed)

Many insurance plans require a doctor’s note that states why this therapy is medically necessary. If you need one, here’s a template to share with your pediatrician.

Doctor Referral Template

To Whom It May Concern:  

I am referring [Child's Name], a [Child’s Age]-year-old with [Diagnosis], for intensive occupational and physical therapy services. Given the child's current developmental challenges and the evidence supporting high-frequency therapy models to stimulate neuroplasticity, I recommend this intensive format to maximize progress and support functional independence.  

 Sincerely,  

[Doctor Name, Title, NPI]

3. Submit the Superbill

Where to Send It

This varies by insurance company. You may:
- Upload it to your insurance portal
- Email it to a specific address
- Mail it with a completed claim form

Use your provider’s exact instructions—missing one step can delay your claim.

Sample Email to Insurance
Subject: Out-of-Network Claim Submission for Pediatric Therapy  >  

Hi [Insurance Company Name],  

I’m submitting a claim for out-of-network occupational and physical therapy services received by my child, [Child’s Full Name], under my plan (Member ID: XXXXXXXX). Attached is the Superbill from RISE Pediatric Intensive Therapy. Please let me know if any additional documentation is needed.  

   Thank you,  

[Your Full Name]   [Phone Number]  [Address]

4. Follow Up Like a Pro

Claims get delayed. Here’s a follow-up phone scrip

"Hi, I submitted a Superbill for out-of-network therapy for my child, [Child’s Name], on [Date]. I’m calling to check on the status and make sure everything is being processed correctly. Can you confirm it was received and let me know if anything else is needed?"

Tips & Tricks for Success
- Get names & reference numbers for every call.
- Keep a folder (physical or digital) with all documentation.
- Follow up weekly until your claim is processed.
- Submit everything together: Superbill, referral letter, and claim form.
- Use child’s full legal name on all documents to match records.

Watch Outs: Common Pitfalls to Avoid
- Submitting without pre-authorization (if required)
- Missing claim forms or details
- Using incorrect diagnosis or procedure codes (RISE provides correct ones)
- Forgetting to follow up

Resources

Navigating insurance reimbursement for pediatric intensive therapy can be complex. To assist you further, here are some reputable online resources that provide additional guidance:

American Occupational Therapy Association (AOTA): Offers strategies for gaining insurance reimbursement for intensive therapy services. ​

American Physical Therapy Association (APTA): Provides resources on reimbursement for pediatric physical therapy services, including coding, billing, and working with insurers. ​

PediatricAPTA.org

Intensive Therapeutics: Shares insights on insurance considerations for intensive therapy programs, emphasizing the importance of understanding your policy's specifics. ​

Transform Pediatric Physical Therapy: Details their approach to billing and provides information to help families file claims for reimbursement. ​

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT): A Medicaid program ensuring comprehensive and preventive health services for children under 21. Understanding EPSDT can be beneficial if your child is eligible for Medicaid. ​

Additionally, it's advisable to consult with your therapy provider's billing department, as they often have experience assisting families with insurance claims and can offer personalized guidance based on your situation.

Final Note

While we can’t guarantee insurance reimbursement, many RISE families have successfully received it using this approach. If you have any questions about the Superbill or need help understanding your codes, contact us—we’re happy to help.