Private and Group Insurance

Private insurance, group health companies, and managed care organizations each bring along their own set of challenges for funding.OTOL Rx maintains specialized service agreements with several managed care organizations.Our program also works informally with private/group insurance companies, such as Anthem Blue Cross, Blue Shield, Aetna, and Motion Picture and TV Fund.

Home and community programs are not a covered benefit under most insurance policies. However, some policies will consider benefit substitution for home and community services when specific client and program status conditions are met. There are also situations whereby our office can explore setting up an individualized agreement for service authorization with the funding company on a case-by-case basis. Reimbursement will often be negotiated in accordance with in-network payment terms. Our goal is to maximize benefit coverage through obtained authorization and minimize out of pocket financial responsibility to the client and family.