Patient Financial Responsibility Policy

Thank you for choosing Heartspring as your outpatient therapy provider. We are committed to building a positive relationship with you and your family. Your clear understanding of our patients’ financial responsibility is important to our professional relationship. Please understand that payment for services is part of that relationship. Please ask if you have any questions regarding this information.

Proof of Insurance

To serve you and your family to the best of our ability we must obtain a copy of your current valid insurance card as proof of insurance. If you fail to provide us with the correct insurance information in a timely manner you may be responsible for the balance of your claim

Coverage Changes

If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim due to coverage changes, the balance will automatically be billed to you.

Verifying benefits and coverage

As a courtesy to you, we contact your insurance company to verify benefits and coverage. It is your responsibility to inform us in writing and present changes to insurance when they occur. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of your claim. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits.
Please note: Heartspring is designated as an outpatient facility. As a result, charges may be higher or charged differently than they would be at a clinic affiliated with hospitals.

Non-Covered Services

Please be aware that some, and perhaps all, of the services you receive may not be covered or considered reasonable or necessary by Medicaid or other insurers. You must pay for these services in full at the time of visit or contact our billing department for payment arrangements. If no payment arrangement has been made, payment in full at time of service is required.


Co-pay is due at the time of service. Failure to do so may result in removal from the schedule until payments are made in full.

Insurance claims

In order to properly bill your insurance company, we require that you disclose all insurance information including primary and secondary insurance, as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance.

Nonpayment/Outstanding Balance

Statements are sent to the insured party the first week of each month. Account balances must be paid in full each month. Payment plans are available on a case by case basis but must be approved by a Team Lead. A payment plan letter will be mailed out if account is past due for 60 days and are only valid if signed and returned. If payments are not made per payment plan, the account will be turned over to a collection agency without further contact and patient will be removed from the schedule immediately. Patients are also subject to removal from the schedule if account is delinquent with no payment or contact for 90 days. If at this time, no contact is made, the account will be handed over to a collection agency. If statements are returned and reasonable means of obtaining current address are exhausted, accounts will be turned over to a collection agency.


Insurance plans are now requiring an authorization from your insurance company, a referral from your doctor, or in many cases, both. Typical timeframe for obtaining this information is a minimum of two weeks. If we are unable to obtain the needed documentation prior to your first appointment, we will contact you to cancel. You will also have the option of paying out of pocket rates at this time. If we are unable to obtain the needed documentation due to lack of medical necessity, you will be responsible for any incurred costs.

Financial assistance

Through generous donations Heartspring Outpatient Services is provided the opportunity to extend financial assistance to children in need of therapy. All inquiries are considered. If there is an inability to pay for services, if insurance is denied and/or insurance has covered the maximum benefit, you may be eligible for financial assistance. Financial assistance qualification is based on gross income, number of members in the household, and how many therapy sessions are needed. This scale was developed based on current federal poverty guidelines. Financial assistance considerations are good for one year and must be renewed annually. Financial assistance payment is due at the time of service. Failure to do so could warrant a loss in funding or scheduled therapy time.