Welcome to Creative Speech Solutions!

We are your child's #1 cheerleaders, celebrating victories big and small.

 

We strongly believe that working together as a team is imperative in maximizing the progress made by each child we treat. Each of our professionals contributes his/her individual knowledge and expertise, which allows a clear picture to be created of every child’s areas of challenge, and just as importantly, areas of strength. The CSS philosophy is to provide a warm, nurturing and fun environment to help children reach their maximum potential, one step at a time.

We cannot initiate therapeutic services until signed authorization is provided.

I understand and agree that I am personally responsible for charges incurred for services rendered by the office of Creative Speech Solutions, LLC if any of the following apply:

1. My health plan/school district does not cover 100% of the services rendered for any reason.
2. I do not provide the office of Creative Speech Solutions, LLC with the correct insurance information.
3. I have chosen not to use my medical coverage at the time services are rendered.
4. I have a health plan that considers this office to be out of network or not otherwise a covered provider of service.
5. I have not obtained a referral, preauthorization or other required authorization.
6. My benefit parameters limit or exclude coverage for therapy services.
7. My coverage changes during the course of therapy and/or no longer covers/limits or excludes therapy services.
8. I exceed my benefit limitations.

I understand and agree that in-network or out-of-network claims not paid by my insurer/school district after 60-days become the responsibility of the guarantor/subscriber.
I further understand and agree that if I appeal my insurance company’s decision regarding coverage, I will pay for services (past and present) until the appeal process is complete.

I understand and agree that if Creative Speech Solutions, LLC submits my claim(s) for services as an in-network provider, bills for services rendered but not allowed, covered or reimbursed to Creative Speech Solutions, LLC by my insurer are due upon receipt of said bill. All other bills for services rendered are also due upon receipt, including but not limited to bills for co-pays, deductible amounts, and therapy. I also understand and agree to pay interest at a yearly rate of 12% on any remaining balance not paid within 60 days from the date of any bill. I understand and agree to pay any collection fees or costs, attorney’s fees, and/or related costs and expenses incurred in pursuing any balance not paid within 90 days from the date of the bill.

I understand and agree that all outstanding balances that I have not paid within 60 days will be charged to the credit card I have on file with Creative Speech Solutions, LLC.

I also understand that Creative Speech Solutions, LLC is only in network with Aetna and Cigna for Speech and Language Therapy, Feeding Therapy, and AAC and is not in network with any insurance carriers for Occupational Therapy.

I have read and understand the policies and procedures set forth by Creative Speech Solutions, LLC which are listed on our website and this Patient Liability Statement. By signing below, I hereby agree to the terms, conditions, and provisions therein, and authorize Creative Speech Solutions, LLC to provide services to my child.

Please charge the credit card on file on a monthly basis for services and/or copayments. I understand that a receipt will be emailed to me once the card is charged and payments have been applied to my account.

I acknowledge and understand that the credit card on file is for services rendered on my behalf and at my request by Creative Speech Solutions, LLC. I acknowledge that, by providing this service Creative Speech Solutions, LLC has met its obligations for these charges. In the event that I am more than 60 days overdue in paying my outstanding bill, I give Creative Speech Solutions, LLC consent to charge this credit card. I acknowledge that this agreement may be cancelled with written notice at any time.

Please note that CSS is in-network with Cigna and Aetna for services for speech-language/AAC and feeding therapy. We are happy to bill your out-of-network provider for all other services. We are not certified to bill Medicaid.

I hereby authorize Creative Speech Solutions, LLC, to assess and treat the above-named client using appropriate assessment and treatment procedures.

 

AUTHORIZATION TO RELEASE INFORMATION

 

I further authorize Creative Speech Solutions, LLC, to release information acquired in the course of evaluation and/or treatment to appropriate individuals/insurance companies/facilities/schools in order to coordinate services or receive reimbursement. This may include treatment reports, progress notes, and general discussion of the child (e.g. behavioral management, therapy goals, etc.). Individuals may include the child’s pediatrician, other physicians (e.g. neurologist), other treating therapists (e.g., school SLP, occupational therapist, etc.), and other specialists (e.g., psychologist). 

I hereby release Creative Speech Solutions, LLC, and any of its employees and colleagues from all claims of every kind on account of such use. I further consent to the reproduction and/or authorization by Creative Speech Solutions, LLC to reproduce and use said video/audio recordings of my child’s voice and or photographs. I understand the above authorizations may be rescinded at any time when presented in writing by myself or other authorized legal guardians to Creative Speech Solutions, LLC.