Transparency and Sustainability

At Skyrocket Pediatric Therapy Foundation, our mission is to see your child reach their full potential. We also pride ourselves on recruiting and retaining the most skilled and passionate therapists in the field. We are able to offer this high level of expertise because we provide our team with a stable professional environment and a guaranteed income.

Our therapists are dedicated professionals who invest deeply in your child’s journey. By respecting their time and honoring your scheduled appointments, you help us maintain a supportive culture where our clinicians can focus entirely on your child’s growth. When families demonstrate a mutual commitment to our policies, it allows us to keep the best therapists on our team—ensuring your child receives the consistent, high-quality care they deserve.

Why Understanding Your Insurance Matters

Insurance is a complex contract between you and your provider. While we do our best to assist with billing, it is essential that you understand your specific benefits to avoid unexpected financial burdens. Surprises in coverage, such as unmet deductibles or non-covered services, can lead to large balances that families may not be prepared to pay. For our organization, these "surprises" can result in significant financial losses that directly impact our ability to operate. By staying informed about your benefits, you help ensure that resources stay focused on your child’s clinical progress rather than administrative disputes.

The Importance of Attendance

Consistency is the single most important factor in a child’s progress. When sessions are missed, the momentum of therapy is broken, and it takes longer to reach goals.

Beyond clinical efficacy, a strict attendance policy is vital to our sustainability:

• Professional Commitment: When you schedule a session, we reserve a dedicated time slot specifically for your child. Our therapists are professionals who arrive on-site having spent time planning and preparing for your child's unique needs.

• Fair Wages: To retain the best talent and provide high-quality services, we must pay our team for the time they have committed to your family. Unlike other industries, a "no-show" in therapy cannot be easily filled at the last minute.

• Organizational Health: As a foundation, our ability to keep our doors open depends on full schedules and reliable payment for the work performed.

• By adhering to these policies, you are not just following a rule, you are supporting the clinicians who support your child and ensuring that Skyrocket remains a strong, effective resource for our entire community.

Insurance & Billing Policies

OUR NETWORK STATUS

We are In-Network providers for:

• Tricare

• Blue Shield of California

• Select Blue Cross Blue Shield (BCBS) plans

• Inland Regional Center (IRC)

  
  

Regarding IEHP: 

We are not in-network with IEHP. However, we can occasionally obtain a Single Case Agreement (also known as a Letter of Agreement or LOA). While we can explain how this process works, the responsibility for initiating and managing this request lies solely with the client.

PRESCRIPTIONS

Some insurance plans require a doctor’s prescription or a formal referral before therapy can begin. While we will try to verify if each plan requires this, it is the responsibility of the client to know if this is a requirement for their plan.

AUTHORIZATIONS

• For Tricare, IRC, and IEHP, we will always wait to receive a formal Authorization before scheduling sessions. This authorization is a "promise to pay" from the insurance company for a specific number of sessions.

  • IRC: We require a POS (Purchase of Service) from your Service Coordinator. Our vendor code is PJ5930 and the SVC (service code) is 116.

• For these specific plans, we will track your session counts and submit the necessary paperwork to request extensions. If an authorization expires and the insurance company is slow to send a new one, we may need to pause services until the new paperwork is received. In the case of a delay, we will notify you and request that you contact your insurance company.

  
  

IMPORTANT INFORMATION FOR BLUE SHIELD AND OTHER PLANS

While we do our best to verify your coverage through online portals and phone calls, insurance companies frequently provide us with conflicting or inaccurate information.

We strongly recommend that you call your insurance provider personally to verify the following:

1. Is a pre-authorization or prescription required for Speech or Occupational Therapy?

2. Do you have a deductible? (The amount you must pay out-of-pocket before insurance begins to pay).

3. What is your Copay or Coinsurance per session (the set amount or percentage that you have to pay each session, even after the deductible is met)?

4. Is there a limit on the number of sessions allowed per calendar year?

5. Are session limits combined? (e.g., if you have a 20-visit limit, does that include Physical Therapy or other services used elsewhere?)

   
   

BILLING AND RESPONSIBILITY

• Payment Notification: Insurance companies often take several weeks or even months to process claims. If your insurance denies a claim or informs us later that you have an unmet deductible, there may be several weeks of "back-billed" sessions that you will be responsible for paying directly.

• Tracking Limits: While we track the sessions held at our clinic, we cannot see if you are using your benefit limits at other facilities (such as for Physical Therapy). It is the client’s responsibility to track their total annual session usage.

• Financial Responsibility: Ultimately, the client is responsible for knowing their plan details. Any costs not covered by insurance (including copays, coinsurance, and deductibles) are the responsibility of the parent or guardian. Referring to the Explanation of Benefits (EOB) provided by your insurance is helpful in understanding those costs.

  
  

ANNUAL POLICY UPDATES

It is important to be aware that most insurance benefit cycles run on a calendar year (January 1st through December 31st). Because of this, your coverage and out-of-pocket costs may change automatically at the start of the new year.

What Happens on January 1st?

• Deductible Reset: Even if you met your deductible in the previous year, it will reset to zero on January 1st. You will be responsible for the full cost of sessions until your deductible is met again for the new year.

• Rate Changes: Insurance companies often update their plans annually. This means your copay (flat fee) or coinsurance (percentage of the cost) may increase or decrease based on your employer's or provider's new contract.

• Session Limit Reset: Your annual "bucket" of allowed sessions will reset. If you have a plan with a 20-visit limit, those 20 visits begin counting again in January.

We are not notified by insurance companies when your plan details change at the start of the year. It is the client’s responsibility to be aware of any changes to their plan, including new deductibles or updated payment amounts. We recommend calling your insurance provider every January to confirm your new benefit details to avoid unexpected billing charges.

IMPORTANT INFORMATION TO HAVE ON HAND WHEN CALLING YOUR INSURANCE

Common Billing Codes (CPT Codes)

When calling, parents should ask: "Are the following CPT codes covered under my plan for a developmental diagnosis?"

• SPEECH THERAPY

  • Speech Therapy Evaluation: 92523

  • Speech Therapy Treatment: 92507

• FEEDING THERAPY

  • Feeding Therapy Evaluation: 92610

  • Feeding Therapy Treatment: 92526

• OCCUPATIONAL THERAPY

  • Occupational Therapy Evaluation: 97165 (Low Complexity) or 97166 (Moderate Complexity)

  • Occupational Therapy Treatment: 97530 (Therapeutic Activity)

Diagnosis Codes (ICD-10)

Ask us for the "suspected" diagnosis code if you do not know one.

• F80.0 - Phonological Disorder (Articulation/Speech-sound disorders)

• F80.1 - Expressive Language Disorder (Difficulty expressing thoughts/ideas)

• F80.2 - Mixed Receptive-Expressive Language Disorder (Difficulty understanding and using language)

• F80.81 - Childhood Onset Fluency Disorder (Stuttering)

• F80.82 - Social Pragmatic Communication Disorder (Social communication difficulties)

• F84.0 - Autistic Disorder

• R13.11 - Dysphagia, oral phase

• R48.2 - Apraxia (Difficulty coordinating muscle movements for speech)

• R63.31 - Pediatric Feeding Disorder, Acute (Under 3 months duration)

• R63.32 - Pediatric Feeding Disorder, Chronic (Over 3 months duration)

Ask:

1. "Are there any specific diagnosis codes that are excluded from my Speech or OT benefits?"

2. Always ask the insurance representative for a Call Reference Number. If the insurance company gives you incorrect information (e.g., saying a service is covered when it isn't), having a reference number allows you to dispute the claim later. Without this number, it is very difficult to hold the insurance company accountable for the information they provided.

Our Provider Information (NPI and Tax ID)

This information is specific to our facility.

• NPI Number: 1821795451

• Tax ID: 872744121

• Clinic Address: 26856 Adams Ave., Suite 100A, Murrieta, CA 92562

The "Out-of-Network" (OON) Question

If you find that we are out-of-network, ask:

• "Does my plan have Out-of-Network benefits?"

• "If so, what is my Out-of-Network deductible and coinsurance?"

• "Do you accept 'Superbills' for reimbursement?" (A Superbill is a detailed receipt we provide that the parent submits to insurance themselves to get paid back).

Attendance and Cancellation Policies

Attendance Policy for Evaluations and Treatment Sessions

EVALUATIONS

Evaluations can be rescheduled or cancelled, but notice must be sent to scheduling@skyrockettherapy.org a minimum of 24-hours in advance. Failure to do so will result in $185 charged to the credit card on file. Evaluation appointments will only be confirmed once the “Recurring Payment Authorization” form has been completed and credit card information has been uploaded into the client portal on Simple Practice.

TREATMENT SESSIONS

We understand that life happens. To provide flexibility while maintaining consistency, we allow for the following:

• Monthly Limit: You may reschedule up to two (2) sessions per calendar month.

• Advanced Notice Required: All cancellations—including those due to illness—must be rescheduled before the original session time starts.

• Excessive Absences: If more than two sessions are cancelled in a month, those additional sessions are forfeited, and a cancellation fee will apply.

• Teletherapy: Teletherapy may be an option (if appropriate for your child and if discussed with your therapist) as an alternative to missing a session when your child is sick or out of town or as an option for makeup sessions.

  
  

How to Reschedule Treatment Sessions:

If you cannot attend your scheduled session, notice must be sent to BOTH scheduling@skyrockettherapy.org  AND your child’s therapist (FIRSTNAME@skyrockettherapy.org).

• Notice must be sent BEFORE the session begins

• Your email must include your specific availability (date and time) for a make up session.

  • For example: “Please reschedule the session on 1/15. I am available to make up the session on 1/17 or 1/18 between 2-4 pm.”

• The cancelled session must be rescheduled and confirmed by the end of the cancelled session day.

• Regularly scheduled sessions cannot be extended to accommodate makeup sessions.

  • For example, if your child’s session is normally 30 minutes, we cannot extend it to an hour to make up for a missed session.

• Failure to provide notice before the session, failure to provide availability, and/or failure to reschedule the missed session will result in a cancellation fee charged to the credit card on file.

  
  

Important:

• Rescheduling a missed session is the responsibility of the caregiver.

• We will do our best to make that session up within the following month, but we cannot guarantee that we will have availability.

• If you reschedule a session and then are not able to attend the rescheduled session, payment is due but the session will be forfeited.

• If you’ve attempted to attend a session and cannot complete the session due to behavioral challenges, emotional dysregulation, or non-emergency medical issues, the session will be billed as a regular session.

  
  

Cancellation Fees

Insurance companies do not pay for missed appointments. If a session is missed and not rescheduled in advance, the credit card on file will be billed the following amounts:

• $79 will be charged for a missed HALF HOUR session.

• $119 will be charged for a missed 45 MINUTE session.

• $158 will be charged for a missed 60 MINUTE session.

Our therapists will use that session time to plan and prepare materials for your child's upcoming sessions, review treatment plans, coordinate with other involved professionals, update your child's home program, etc.

DISCONTINUATION OF SERVICES

If you plan to discontinue services for any reason, we require a minimum of two weeks' notice. Please be advised that failure to provide this notice will result in billing for the sessions scheduled during that two-week period.

Availability

Please select ALL times you are available for sessions for each day of the week.

Acknowledgment and Agreement of Clinic Policies

By signing below, I acknowledge that I have received, read, and fully understand the information provided regarding insurance benefits, attendance, and billing policies.

I have been given ample opportunity to ask questions regarding these policies and have those questions answered to my satisfaction.

I understand that my family is expected to abide by above policies as a condition of receiving services at Skyrocket.

I further acknowledge that I am financially responsible for any balances as outlined in the billing and insurance sections provided to me during this intake process.