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Process

Out of Pocket/No Insurance

If you do not have insurance or plan to pay out-of-pocket for services, we do accept private pay. Please contact our billing department to discuss pricing at info@dgtherapy.com

John Doe

Process

Ask your Primary Care Physician (PCP) to submit a referral request to your insurance company. You have the option of requesting DG Therapy Group as the provider. It is at the discretion of the HMO to decide which provider they will refer.Upon referral, call the DG Therapy Group billing department to verify your covered insurance and ensure the HMO faxed the authorization. Once confirmed, the Case Manager from DG Therapy Group will follow up and schedule your evaluation/treatment.

Resources

Application Submission Form

Eligibility Verification Form

Client Info

Client Name
DOB

Name of Policy Holder
Relationship
DOB

Client Address
Client Phone Number

Plan Information

Insurance Carrier
Insurance Phone Number

Id Number
Group #

Insurance Plan or Program Name

Please Select All that Apply

Speech TherapySpeech Therapy EvaluationSpeech Therapy Re-Evaluation
Occupational TherapyOccupational Therapy EvaluationOccupational Therapy Re-Evaluation
Physical TherapyPhysical Therapy EvaluationPhysical Therapy Re-Evaluation

* Required

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Out of Pocket/No Insurance

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HMO Intake Process

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PPO Intake Process

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