Forms, Insurance & Policies
New Patients: Please download and print for your age group below. Please bring all completed forms to your therapy appointment.
The Therapy Center currently participates in the following insurance plans:
BlueCross BlueShield of Tennessee
United Health Commercial
Tenn Care Select (BlueCare)
TEIS (Tennessee Early Intervention System)
Our staff will assist you with authorizations, but please check the participation status of your plan.
It is very important for our clients to come as consistently as possible to make the most significant progress. Also, our therapists have very busy schedules and generally have clients waiting for weekly therapy appointments. For these reasons, we expect our pediatric clients to attend their scheduled therapy sessions at least 50% of the time during a month. It is very important that parents contact therapists as soon as possible to cancel an appointment, so that another client can be scheduled in that spot. If a client misses more than 50% of their appointments in a one-month period, that appointment time will be offered to the next client on the waiting list. You will receive a letter in the mail if this happens to you. When you receive the letter, you will need to contact the Therapy Center to let them know whether or not you want your child placed on the end of the waiting list. If you do not contact the Therapy Center, your child will NOT be placed on the waiting list.
We realize that there are situations which need special consideration, such as serious illness, hospitalizations, etc.
Financial Responsibility Policy
I understand that the payment of any invoice for services provided to me (or the patient for whom I am signing as the responsible party) is my responsibility to pay in a timely manner. Provider files insurance on Patient’s behalf, but in the event that payment is not forthcoming within 30 days of the date of invoice, I understand that I may be invoiced for the outstanding balance and payment is expected within 15 days of receipt of invoice.
Any service invoiced shall be due and payable within fifteen (15) days of the receipt of invoice.
Failure to pay any invoice within 45 pays of invoice date shall subject the balance due to an additional interest charge in the amount of 1.5% per month or $5.00 (whichever is more). This sum shall be added to the outstanding balance and must be paid just as the payment for services is expected. The interest or fee shall be added each month to the invoice balance until paid in full.
In the event that an invoice balance exceeds six (6) months from the date of original invoice, Patient or Responsible Party understands that Provider may undertake collect services of Providers’ choice, up to and including litigation. In the event any such services are necessary to collect the invoice, Patient or Responsible Party agrees to be fully responsible for the cost of any such collection services or litigation including, but not limited to attorney fees and court costs.