Terms and Conditions
The following Terms and Conditions apply to speech language services provided at Speech Pathway, LLC. as well as all programming and/or services rendered by Speech Pathway LLC.
These are the terms and conditions for receiving services at Speech Pathway LLC. This document is known as the “Terms and Conditions”. In addition to these Terms and Conditions all members participating in speech language services must agree to and follow the Policies and Procedures found at www.speechpathway.net.
To receive services at Speech Pathway LLC., you agree to be bound by the Terms and Conditions which include:
- Insurance Agreement
- Confidentiality Agreement
- Early Intervention vs. Developmental Acquisition
- Interpreter Services
- Access to Records Policy
- Type and Frequency of Documentation Statement
- Appointment Cancellation Policy
- Medical Necessity Statement
- Termination and Dismissal Statement
- Policies and Procedures Statement
“Speech Pathway’s Terms and Conditions are posted and periodically updated on our website at www.speechpathway.com. It is the responsibility of all Clients/Legal Guardians to review and understand these informational documents. Please direct any questions regarding these documents to email@example.com
This Insurance Agreement (the “Agreement”) is made and entered into between (“Legal Guardian”) and Speech Pathway LLC.
- I Legal Guardian must make sure the office is aware of any name, address, phone and/or insurance information changes before the appointment.
- I Legal Guardian am responsible for contacting my insurance company and understanding speech-language coverage terms before evaluation or therapy begins at Speech Pathway
- I Legal Guardian agree to pay for any and all medical/therapy services I receive from Speech Pathway including those that my insurance company refuses to pay, for whatever reason. Speech Pathway will file a claim on my behalf (if contracted with my insurance company), however, if my insurance company denies payments for any reason (e.g. non-covered services, services not medically necessary, my failure to obtain a referral, etc.), I will pay these charges promptly upon written/verbal notification of this refusal. If the insurance company requests additional information for processing your claim, Speech Pathway will promptly comply only one time; there will be no multiple re-filing of claims. It is further understood that no appeals will be filed by Speech Pathway on my behalf.
- I Legal Guardian understand that failure of my insurance company to pay within 60 days of claim filing date will be considered a refusal to pay and I will be responsible for payment in full due upon receipt of notification.
- If your account is delinquent, your balance will be turned over to a collection agency and a collection fee of $75.00 or double your balance will be added.
This Confidentiality Agreement (the “Agreement”) is made and entered into between (“Legal Guardian”) and Speech Pathway LLC. (“Covered Entity”).
The parties acknowledge that Legal Guardian may incidentally or inadvertently encounter, view or access certain Confidential Information maintained by Covered Entity which may qualify as Protected Health Information (“PHI”) or electronic PHI within the meaning of the Health Insurance Portability and Accountability Act of 1996, as amended, and the privacy and security standards promulgated pursuant thereto (“HIPAA”).
NOW, THEREFORE, in consideration of the mutual promises contained herein, as well as other good and valuable consideration, the parties hereto agree as follows:
- “Confidential Information” means any and all non-public, medical, financial and personal information in whatever form (written, oral, visual or electronic) possessed or obtained by either party. Confidential Information shall include all information which (i) either party has labeled in writing as confidential, (ii) is identified at the time of disclosure as confidential, (iii) is commonly regarded as confidential in the healthcare industry, or (iv) is Protected Health Information as defined by HIPAA.
- Legal Guardian agrees to maintain the confidentiality of any Confidential Information, including Protected Health Information that it may incidentally or inadvertent encounter, view or have access to while providing the services under the terms and conditions set forth in this Agreement.
- Legal Guardian agrees not to further use or disclose any Confidential Information, including Protected Health Information that it incidentally or inadvertently views or obtains access to and further agrees to implement appropriate safeguards to prevent any further use or disclosure of any Confidential Information that is incidentally or inadvertently access
- Legal Guardian agrees to report to the Covered Entity any use or disclosure of Confidential Information in violation of this Agreement, HIPAA or any other federal, state or local law or regulation.
- Legal Guardian agrees to comply with all applicable laws and regulations, including HIPAA and the HITECH Act, to the extent applicable, in meeting their obligations under this Agreement.
- The obligations of confidentiality and non-use and non-disclosure under this Agreement will continue indefinitely from the effective date of this Agreement.
- This Agreement may be modified or amended only with the written consent of both parties.
- No waiver of any provision of this Agreement, including this paragraph, shall be effective unless the waiver is in writing and signed by the party making the waiver.
Early Intervention vs. Developmental Acquisition Statement
Early intervention is the process of providing services, education, and support to young children who are deemed to have an established condition, those who are evaluated and deemed to have a diagnosed physical or mental condition (with a high probability of resulting in a developmental delay), an existing delay or a child who is at-risk of developing a delay or special need that may affect their development or impede their education. The purpose of early intervention is to lessen the effects of the disability or delay. Services are designed to identify and meet a child’s needs in five developmental areas, including: physical development, cognitive development, communication, social or emotional development, and adaptive development.
Developmental Acquisition in Child development refers to how a child becomes able to do more complex things as they get older. Development is different than growth. Growth only refers to the child getting bigger in size. Normal development involves the following skills:
- Gross motor skills: using large groups of muscles to sit, stand, walk, run, etc., keeping balance and changing positions
- Fine motor skills: using hands to be able to eat, draw, dress, play, write, and do many other things
- Language skills: speaking, using body language and gestures, communicating, and understanding what others say
- Cognitive skills: thinking skills including learning, understanding, problem-solving, reasoning, and remembering
- Social skills: interacting with others, having relationships with family, friends, and teachers, cooperating and responding to the feelings of others.
Speech Pathway follows the Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Guidelines set forth by the American Speech Language Hearing association (ASHA). The four guiding principles that reflect the current consensus on best practices for providing early and effective communication interventions for infants and toddlers (birth to age 3 years) serve as a foundation for the design and provision of services. Specifically, services are (a) family-centered and culturally responsive; (b) developmentally supportive and promote children’s participation in their natural environments; (c) comprehensive, coordinated, and team-based; and (d) based on the highest quality internal and external evidence that is available. Read more
American Speech-Language-Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: guidelines . Available from www.asha.org/policy.
In accordance with the American Speech-Language Hearing Association’s Code of Ethics, Speech Pathway is happy to offer referrals and resources for families requiring Interpretation services.
American Speech-Language-Hearing Association. (2016). Code of ethics . Available from www.asha.org/policy/.
Access to records
In accordance with the Health Insurance Portability and Accountability Act 45 CFR § 164.524, Upon request, Legal Guardians have the right to inspect or obtain a copy, or both, of the PHI, as well as to direct the covered entity to transmit a copy to a designated person or entity of the individual’s choice. Individuals have a right to access this PHI for as long as the information is maintained by a covered entity, or by a business associate on behalf of a covered entity, regardless of the date the information was created; whether the information is maintained in paper or electronic systems onsite, remotely, or is archived; or where the PHI originated (e.g., whether the covered entity, another provider, the patient, etc.).
Type and frequency of documentation
Documentation of performance including data for goals targeted and progress made will be recorded as mandated by insurance, typically for every appointment attended. Group services that do not require medical documentation for insurance will have informal documentation as warranted. At Speech Pathway, we will hold a meeting with parents approximately every 90 days to discuss the current progress and the individualized plan of intervention.
Appointment Cancellation Policy
We strive to render the highest quality speech language services. In an attempt to be consistent with this, we have an Appointment Cancellation Policy that allows us to schedule appointments for all patients. When an appointment is scheduled, that time has been set aside for you and when it is missed, that time cannot be used to treat another patient. Our policy is as follows: We require that you give our office 24 hours notice in the event that you need to cancel/reschedule your appointment. This allows for other patients to be scheduled into that appointment. We allow 3 cancellations/reschedules per 90 day period. If you miss an appointment without contacting our office within the required time, this is considered a No Show appointment. After 3 No Shows your child’s appointment spot will be removed from the schedule and offered to other clients. If you have any questions regarding this policy, please see our Policies and Procedures or contact our office and our staff will be glad to clarify any any questions you have.
Medical Necessity & Termination of Services
According to the American Speech Language Association (2018), Audiology and Speech-Language Pathology services are medically necessary to treat speech-language, swallowing, cognitive communication, hearing, and balance disorders. Many of these disorders—such as head injury, Parkinson’s disease, stroke, autism, and cerebral palsy—have a neurological basis. Determining medical necessity takes into consideration whether a service is essential and appropriate to the diagnosis and/or treatment of an illness, injury, or disease. The U.S. National Library of Medicine defines disease as “an impairment of the normal state.” Loss of hearing, impaired speech and language, and swallowing difficulties all reflect an impairment of the normal state, and services to treat such impairment must be regarded as meeting medical necessity.
Habilitation services, referenced in the ACA definition of medical necessity, treat illness, injury, condition, and diseases (or symptoms) and, thus, should be included in definitions of medical necessity. Developmental deficits requiring habilitation services meet medical necessity. A diagnosis of developmental deficit in a child indicates an abnormal state of function, and speech, language, and hearing services are as medically necessary for this patient as they are for an adult who has suffered a stroke and has lost speech and language function.
American Speech-Language-Hearing Association (2018). Medical Necessity for Audiology and Speech-Language Pathology Services. Retrieved from http://www.asha.org/practice/reimbursement/medical-necessity-for-audiology-and-SLP-services/
Dismissal & Termination Statement
Dismissal/Termination of Speech Services either permanently or for some specified time period, are set forth in accordance with the American Speech-Language Hearing Association Code of Ethics. The factors for dismissal/termination taken into account include: 1. Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected. 2. Individuals shall not guarantee the results of any treatment or procedure, directly or by implication; however, they may make a reasonable statement of prognosis. Further, Speech Pathway has the right to terminate services at any time. Read more about termination and dismissal from services in our Policies and Procedures.
Policies and Procedures
Speech Pathway is committed to providing every child with medically necessary Speech-Language services. Prior to beginning services all parents will be provided and asked to sign a copy of our Policies and Procedures. Our Policies and Procedures are available on our website at www.speechpathway.net.