FORMS & FEES


New Client Forms


All forms listed below will be automatically sent for completion once the Client Portal has been set up by clicking on the orange “Request Appointment” button below. The client portal is used to book all appointments, pay for services electronically and send/receive documents during the treatment period. PDF versions of all forms are found below for your convenience. 

 

Policy Review and Procedures Fees for Services Cancellation Policy Release of Information Consent
Autorización y Pólizas Honorarios y Responsabilidad de Pagos Politica de Cancelación Autorización para la Divulgación de Información


Insurance 


Voz Speech Therapy is currently an out-of-network provider with all insurance companies, however that does not mean your insurance will not cover some or all services. Depending on your current plan and company, your insurance may still be billed for reimbursement. It is important to check with your insurance company beforehand to determine what steps you need to take for reimbursement of services. All paperwork with appropriate coding for services rendered will be provided once a month in the form of a Superbill. Progress reports, summaries and medical necessity statements may be provided upon request. Please note payment is due the day services are rendered. 

Some steps to take when calling your insurance company before starting therapy:

1. Call the Member Services number on the back of your insurance card and ask the person on the phone what the coverage for speech therapy is with an out-of-network provider.

2. Provide your child’s name, date of birth and insurance member ID/group policy number. When asked, the provider is Ana-Maria Jaramillo, M.S., CCC-SLP at Voz Speech Therapy, LLC. D.C. license #SLP001221, M.D. license #08902 V.A. #2202008834, NPI #1306242243, ASHA Certification #14092216. 

3. During our initial phone call, I will provide you with a list of codes you can reference for reimbursement depending on the information you provide me about your child. These are ICD codes that your insurance company will need to process claims.

4. Don’t hesitate to ask your insurance company questions while on the phone such as: “Do I need pre-authorization for speech therapy? What forms do I need to submit when filing a claim? When do I need to file a claim by? What information do you need from the speech therapist? What happens if you deny my claim?”