Let’s Talk About Insurance

Insurance can feel confusing. Big words. Lots of rules. Surprise bills.

Let’s break it down in a simple way.

First — Who Is Marigold in This?

Marigold is a third-party biller.

That means:

• We provide speech therapy. We provide occupational therapy.

• We send claims to your insurance company.

• Your insurance decides what they will pay.

You do not have a contract with Marigold about your insurance plan.

You have a contract with your health insurance company.

Your insurance company decides:

• What services are covered

• How much they will pay

• What you must pay

We do not control those rules.

We Verify Your Insurance First

Before starting services, we run an initial insurance verification.

This means we contact your insurance company to check:

• If speech therapy and/ or occupational therapy is covered

• If we are in-network or out-of-network

• Your deductible

• Your co-pay

• Your co-insurance

This gives us an idea of what to expect for coverage and possible out-of-pocket costs.

Important:

Insurance verification is not a guarantee of payment. It is an estimate based on the information your insurance company gives us at that time.

Meet Our Biller

Our billing is handled by Alex at Lakefront Billing Services.

If you have billing questions, you can contact:

Alex

📞 414-434-8512

She can help explain:

• Claims

• Insurance processing

• Balances

• What is still owed

Primary and Secondary Insurance

Some families have more than one insurance.

Primary Insurance

This plan pays first.

Secondary Insurance

This plan may help pay what the primary does not.

But secondary insurance does not always pay everything left over. It depends on your plan rules.

Types of Insurance Plans

There are different kinds of insurance.

HMO (Health Maintenance Organization)

• Usually needs a doctor referral.

• Must stay in network.

• Can have stricter rules.

PPO (Preferred Provider Organization)

• More flexibility.

• Often no referral needed.

• Can sometimes go out of network (but it may cost more).

Every plan is different — even if they have the same name.

Important Words to Know

Deductible

This is the amount you must pay before insurance starts paying.

If your deductible is $1,000, you must pay $1,000 first.

Co-Pay

A set amount you pay each visit.

Example: $40 per session.

Co-Insurance

This is a percentage you pay.

If insurance pays 80%, you pay 20%.

If a session costs $100:

• Insurance pays $80

• You pay $20

Why Might We Ask You to Pay Up Front?

This is a common question.

Here’s why:

1. Your Deductible Is Not Met

Insurance may not pay until you meet it.

2. Your Plan Requires Co-Pay or Co-Insurance

Your portion is due at the time of service.

3. Insurance Does Not Guarantee Payment

Even after verification, insurance can:

• Deny a claim

• Apply it to your deductible

• Change how they process it

Because your contract is with your insurance company, you are responsible for what they say you owe.

Why Insurance Literacy Matters

Understanding your insurance helps you:

• Avoid surprise bills

• Plan for costs

• Ask better questions

• Feel more confident

If you are unsure about your benefits, call the number on the back of your insurance card and ask:

• What is my deductible?

• How much have I met?

• What is my co-pay?

• What is my co-insurance for speech therapy? For occupational therapy?

• Is this provider in network?

Write the answers down.

At Marigold Speech & Co., we believe families deserve clear information. We are here to guide you — but your insurance company makes the rules.

Insurance is a system.

When you understand the words, you feel more in control. 💛