Changes coming, effective July 1, 2021: Medicaid Managed Care
North Carolina Medicaid is transitioning to a managed care system. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs). Most Medicaid beneficiaries will be required to enroll with a health plan within the Managed Care Program. Speech Stars is currently contracted with the following Managed Care health plans: AmeriHealth Caritas, Carolina Complete Health, Healthy Blue, United HealthCare Community Plan, and WellCare. Open enrollment begins March 15th, 2021. Beneficiaries should expect a letter in the mail from North Carolina Department of Health and Human Services regarding enrollment. The owners of Speech Stars will contact each current Medicaid beneficiary prior to July 1, 2021 to discuss the MCO selected.
Speech Stars, PLLC is an in-network provider for Blue Cross Blue Shield of NC, MedCost, United Healthcare and Medicaid. We are currently an out of network provider for Aetna. You may be eligible to receive out of network benefits from your insurance carrier. To see if you are eligible, call the customer service number on the back of your insurance card.
If you have insurance concerns, please contact your insurance provider or our office for more information.
Common Insurance Terminology:
Allowed Charges-Amount an insurance company will reimburse an in-network provider for services rendered to their client.
Authorization-Approval from insurance provider for a covered service to be eligible for payment. Often takes 5-7 business days and allows for a maximum number of sessions within a certain time-period.
Co-insurance-The client may be required to pay a certain % of the allowed charges as required by his/her contract with the insurance provider. For example, an insurance provider may 90% and the client may be required to pay 10% of the allowable charges.
Co-pay-The dollar amount a client is required to pay for each date of service.
Explanation of Benefits (EOB)-A description of claims processed by the insurance provider. EOBs typically include the following information: type of service, date(s) of service, billed charges, payments, reasons for denial, and patient responsibility. It is very important that you read your EOBs as we do not track benefit caps on therapy services.