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Insurance Verification Form - Speech Therapy Associates

Insurance Verification Form - Speech Therapy Associates 2025

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The document provides a guide for patients of Speech Therapy Associates in Beaverton, OR, to verify their insurance coverage for speech therapy services. It includes instructions on completing an insurance information form, a list of possible diagnosis and procedure codes relevant to speech therapy, and important disclaimers regarding the use of the form. The document emphasizes the need for detailed communication with insurance carriers to understand coverage limits and requirements.

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Click ‘Get Form’ to open the Insurance Verification Form in the editor.
Begin by entering the basic insurance information. Fill in the 'Insurance Carrier', 'Claims Dept Phone #', 'Insurance ID #', and 'Group #' fields accurately.
Next, provide the member and patient information. Complete the sections for 'Subscriber Name', 'Patient Name', 'Patient Phone Number(s)', and their respective birth dates and addresses.
In the Diagnosis Code(s) and Procedure Code(s) sections, refer to your speech therapist for accurate codes. Enter these codes as needed.
Document your call details by filling in the 'Date of Call' and 'Insurance Representative’s Name'.
Proceed to answer questions regarding coverage benefits, co-payments, deductibles, and any required documentation. Ensure all relevant fields are completed.

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