How do I start

Patient Referral

Ready now?

Complete the information below:

#SuccessStory

Joshua graduated from occupational therapy at TheraTree! He has been working so hard with mom on moving, rolling, and tracking toys. He is having so much playing and we are so proud of all your growth!

Patient Referral

Child's First and Last Name *
Date of Birth *
Parent Name *
Parent/Guardian Email * *
Parent/Guardian Phone *
Patient may need (Select all that apply) *

Psychological Evaluation

Mental Health/Counseling

Behavioral Therapy (ABA)

Occupational Therapy

Speech Therapy

Physical Therapy
Location(s) willing to travel to: *

Owensboro, KY

Henderson, KY

Telehealth
Pediatrician Name *
Primary Concerns & Additional Information About Your Child
How did you hear about us
PRIMARY INSURANCE: Company Name (or Payment Method) *
PRIMARY INSURANCE: Group Policy #
PRIMARY INSURANCE: Policy ID #
PRIMARY INSURANCE: Policy Holder First and Last Name
PRIMARY INSURANCE: Phone
SECONDARY INSURANCE: Company Name
SECONDARY INSURANCE: Group ID #
SECONDARY INSURANCE: Policy ID #
SECONDARY INSURANCE: Policy Holder First and Last Name
SECONDARY INSURANCE: Phone

After submitting the referral form above, you can speed up your child's new patient process by completing the intake paperwork now:

Complete Intake Paperwork

What to Expect

Referral Process: Parents can begin the referral process by completing the patient referral (first tab) OR call us to see if your child will benefit from therapy OR requesting a referral to TheraTree from your pediatrician. We will then request a Physician order if they haven't faxed one to us yet.

Scheduling. Our patient intake specialist will schedule an evaluation with you and you may call us at (270) 688-8449. We understand you reason for getting an evaluation is important and try to schedule as little as within a week.

Paperwork. All legal guardians must complete ouromplete our intake paperwork as soon as possible. We request to have all intake information submitted at least 24 hours before the evaluation. Your information helps us prepare for you evaluation.

The day of your Evaluation:

Telehealth Evaluations:

Log into your Parent portal (or click the email link) and orient yourself 15 minutes before your appointment. For OT evaluations please have the following supplies on hand. These items help us see they way your child can use these "tools" and will enhance the quality of our evaluation. If there are any items you don't have, it's ok, we can still complete your evaluation.

Pencil
Paper
Marker
Crayons
Scissors
Interlocking blocks
Stackable blocks
Puzzle
Favorite toy
Small items that are smaller than the child's hand (5)

In-person Evaluations:

Arrive to your evaluation appointment at least 15 minutes early. This will allow us time to collect information such as your insurance card. If you have not completed in the evaluation packet, please arrive 30 minutes early.

Note: Please respect your scheduled appointment time. Our highly skilled therapists have busy schedules and must complete critical observations and assessments with your child, which typically take the entire allotted time. Without this, your child may not qualify for services.

If you are running late, please call us and let us know. Depending on how late you're running and our schedule, there may be a need to entirely reschedule the appointment.

If you need to cancel, please do so at least 24 hours before your appointment or with as much advanced notice as possible. Advanced notice allows us the time to see another patient during that time and help more families.

PRIVACY PRACTICES

Therapeutic medical treatment and quality of care is one of our highest priorities. We are committed to in the privacy rights of our patients and their families. We are required to provide you with this notice of our legal duties and privacy practices required to maintain the privacy of protected health information. We are required to abide by the terms of this notice currently in effect. We reserve the right to change the terms of our notice and to make the new notice provisions in effect for all protected health information that we maintain. If we do update our notice, we will post a revised notice on our website. You may also request a copy of any revised notice by calling the office and requesting that a revised copy be sent to you in the mail or by asking for one at your time of you next appointment.

Health Insurance Portability and Accountability Act (HIPAA): HIPAA is a federal law published by the US Department of Health and Human Services (45 CFR Part 160 and Subparts A and E of Part 164) in 1996 that sets national standards for protecting sensitive health information. It requires health care providers, including TheraTree, LLC, to safeguard patient Protected Health Information (PHI). HIPAA gives parents and guardians rights over their child’s health information, including the right to access records, request corrections, and understand how information is used or shared. TheraTree, LLC follows HIPAA regulations to keep patient health information private and secure.

Personally Identifiable Information (PII): Any information that can be used to identify your child or your family, either on its own or when combined with other information. Examples include name, address, phone number, date of birth, email address, Social Security number, or photographs and recordings that show identity.

Protected Health Information (PHI): A subcategory of PII that relates specifically to health care. PII becomes PHI when an indiviudal is identified and connected to an their health information. PHI includes any information that identifies your child and relates to their past, present, or future physical or mental health, the care they receive, or payment for health care services. Examples include medical records, therapy notes, diagnoses, test results, treatment plans, and health insurance information. Both PII and PHI are protected by federal and state privacy laws, and TheraTree, LLC safeguards this information in compliance with HIPAA and applicable regulations.

HOW YOUR HEALTH INFORMATION MAY BE USED.

PHI will be used and disclosed as part of rendering care for treatment, payment and, healthcare operations. Access to health information is limited to clinicians involved in care, authorized administrative personnel for billing and compliance, and payer or government auditors when required by law. Federal and state privacy laws permit the use or disclose your PHI without obtaining consent or without giving you a chance to object or agree with the use or disclosure in the following circumstances:

Provide Treatment: We will use your health information within our office to provide you with the best care possible. This may include administrative and clinical office procedures. Because we believe students are the future for providing quality services to our patients, student clinicians, assistants, and interns on our team will have access to your health information, observe, and/or lead treatment. Although volunteers in our volunteer program do not have direct access to health records, they are present in our facility. All students and volunteers have completed HIPAA training and signed HIPAA agreements. We may share your health information with referring physicians/pediatricians/therapists or other health care personnel providing your treatment.

Obtain Payment: We may include your health information with an invoice used to collect payment for treatment you receive in our office. We may do this with insurance forms filed for you in the mail or sent electronically. We will be sure to only work with companies with a similar commitment to the security of your health information.

Conduct Health Care Operations: It is possible that health information will be disclosed during audits by insurance companies or government appointed agencies as part of their quality assurance and compliance reviews. Your health information may be reviewed during the routine processed of certification, licensing, or credentialing activities.

Patient Communication: We may contact you to follow up on your care and inform you of treatment options or services that may be of interest to you or your family. These communications may include postcards, letters, telephone calls, voice mail, bulletins or email.

Abuse or Neglect: We will notify government authorities if we believe a patient is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when we are compelled by our ethical judgment, when we believe we are specifically required or authorized by law or with the patient’s agreement.

Public Health and National Security: We may be required to disclose to Federal officials or military authorities health information necessary to complete an investigation related to public health or national security. Health information could be important when the government believes that the public safety could benefit when the information could lead to the control or the prevention of an epidemic or the understanding of a new medical device.

For Law Enforcement: As permitted or required by State or Federal Law, we may disclose your health information to a law enforcement official for certain law enforcement purposes, included (under certain limited circumstances) if you are a victim of a crime or in order to report a crime.

Family, Friends, and Caregivers: We may share your health information with those you tell us will be assisting you with your treatment or payment. We will be sure to ask your permission first. In the case of emergency, we will use our best judgment when sharing your health information.

Medical Research: Advancing medical knowledge often involved learning from the careful study of the medical histories of prior patients. Formal review and study of health histories as a part of research study will happen only under the ethical guidance, requirements and approval of an Institutional Review Board.

Uses and Disclosures of Therapy Notes: Therapy notes are recorded by a health professional documenting of currently level of functions. progress, and medical need for treatment taken during the session. We may disclosure notes taken for the following limited purposes.

For Treatment: The therapy provider that created the therapy note may use the notes for your treatment or to provide you with health care services/ For example, a physician may review her note prior to your therapy session.

For Training: We may use and disclose therapy notes for our own training programs in which student , trainees, or practitioners learn under supervision to practice to improve their skills.

Legal Action: We may use and disclose therapy notes to defend ourselves in a legal action or other proceeding. For example, we may provide therapy notes to our lawyers who are defending us in a legal case brought by you.

Coroners or Medical Examiners: We may disclose therapy notes to a coroner or medial examiner.

Required by Law: To Avert a Serious Threat to Health or Safety: We may disclose therapy notes when required to do so by law. We may use and disclose therapy notes if we believe that the use or disclosure is necessary to prevent or lesson a serious and imminent threat to the health or safety of a person of the public.

Authorization to Use or Disclose Health Information: Other than what is stated about or where Federal, State, or Local law requires us, we will not disclose your health information without your written authorization. You may revoke that authorization in writing at any time.

TECHNOLOGY

TheraTree, LLC uses audio, video, digital, and artificial intelligence (AI) technologies as part of daily clinical, administrative, and operational activities. This disclosure is intended to inform clients and families of these practices and the safeguards in place to protect Protected Health Information (PHI).

Electronic Systems and Communication: A variety of secure electronic systems are used to support client care and operations, including but not limited to: Electronic Medical Record (EMR) systems, secure patient portals, encrypted email communications, secure text messaging platforms, scheduling and appointment reminder systems, telehealth and virtual care platforms, cloud-based document storage and encrypted backup systems, data analytics tools, training and platforms, digital signature platforms for consents and forms, and online payment and billing platforms. All PHI is stored in TheraTree’s HIPAA-compliant EMR system. Paper materials are digitized for secure storage, with originals destroyed once electronic storage is verified. Records are retained for a minimum of seven (7) years after the last date of service, or longer as required by law or payer policy, after which they are securely destroyed through HIPAA-compliant methods.

Audio and Video Monitoring: Audio and video cameras are located in indoor common areas and outdoor spaces and used for safety, security, training, and quality assurance. Monitoring does not occur inside restrooms or select private therapy rooms.

Recordings and Transcriptions: Remote or in person services and consultations may use HIPAA-compliant videoconferencing platforms and/or other secure devices to facilitate therapy and consultation services. Recordings may be used for transcripts, documentation, supervision, training, quality assurance or operational decision-making.

Artificial Intelligence (AI) Tools: AI technologies are used to support clinical and administrative operations. Examples include transcription services, meeting analysis, clinical support tools, and data organization systems. These tools are implemented to improve care quality, efficiency, and safety, and are used in compliance with privacy and security requirements.

Digital Assessments and Monitoring: Tablet or computer-based testing applications, digital therapy tools, and standardized assessments administered electronically may be used for remote patient monitoring (RPM) and outcomes tracking. Remote therapeutic monitoring (RTM) devices may be incorporated such as smartphone apps or wearable devices to gather activity and/or physiological data as appropriate. RTM services may be billed to the insurance company.

Data Protection and Privacy: All technologies listed in this disclosure and data collected will be maintained in accordance with HIPAA, state and federal privacy laws, and TheraTree, LLC’s internal compliance policies. Data may become part of the patients permanent medical record and will be securely stored, retained only as long as necessary, and disposed of in accordance with applicable law and policy. Protected Health Information (PHI) is safeguarded and access is limited to authorized personnel. Technology and collected data may be reviewed at varying intervals depending upon the patients treatment plan, medical necessity, and clinician availability. Technology is not continuously monitored and should not be used to report emergencies, urgent medical concerns, or situations requiring immediate attention. Call 911 or seek appropriate emergency services as needed. Data is not used for marketing or promotional purposes without separate written consent.

PATIENTS’ RIGHTS

Patient receiving therapy services and their legal gaurdians have the following rights related to health information within the limits of the law.

Access to Care: Receive considerate, respectful, compassionate care regardless of your age, gender, race, national origin, religion, gender preference, or disability. Receive care in a safe environment free from all forms of abuse, neglect, or harassment. Have your property treated with dignity and respect. Change health care providers if dissatisfied with your care.

Informed Care: Be informed of treatment plans and participate in the development and implementation of plan of care. Receive a clear explanation of evaluation results; to be informed of potential or lack of potential for improvement. Be fully informed of the care and treatment that will be provided by us, the cost of care, and how payment will be handled. Be provided with services in a timely and competent manner, which includes referral to other appropriate professionals when necessary. Be told the name of health care provider(s) and the professional qualifications of the person providing services. Be informed of discharge in a timely manner and be involved in discharge planning. Request or refuse treatment, and receive information regarding the consequences of refusing treatment.

Restrictions: Request restrictions on certain uses and disclosures of health information. We will make every effort to honor reasonable restriction preferences from clients.

Confidential Communications: Expect full consideration of patient privacy and confidentiality in care discussions, evaluations, and treatments. Expect that all communications and records about care are confidential, unless disclosure is allowed by law. Request communication in a certain way inlcuding privately with your other family members present or through mailed communications that are sealed. We will make every effort to honor reasonable requests for confidential communications.

Inspect and Copy Your Health Information: Read, review, and copy your health information, including evaluation reports, treatment records, progress notes, and billing records, as permitted by law. Portions of health records include test data (such as responses, scores, and examiner notes) and test materials (such as manuals, test questions, or scoring keys). Under Kentucky law and the American Psychological Association (APA) Code of Ethics, test materials are protected to preserve the validity and integrity of the standardized assessment(s) and cannot be released directly to clients, parents, or other unauthorized persons. Test data may only be released to another credentialed professional who has appropriate training and experience in the specialized testing and who is authorized to receive the data. Specific health information may be withheld if its’ release would pose a risk of harm or lead to misuse or misinterpretation of test results. If you would like a copy of your health information, please let us know by emailing contact@theratreepeds.com. You will be charged a reasonable fee described in the finacial responsibility agreement and in alignment with state regulations for duplication costs.

Amend your Health Information: Ask to update or modify records if you believe your health insurance records are incorrect or incomplete. We will be happy to accommodate you as long as our office maintains this information. In order to standardize the process, requests must be made in writing along with a description of the reason for the change. Requests may be denied if the health information record in question was not created by our office, is not part of our records, or if the records containing health information are determined to be complete and accurate.

Documentation of Health Information: Ask for a description of how and where health information was used by us for any reason other than for treatment, payment or health care operations. Please let us know in writing the time period for which you are interested. Thank you for limiting your request to no more than six years at a time. We will charge a reasonable fee for these request define in our finacial responsibility agreement.

Request a Paper Copy of this Notice: Obtain a copy of this Notice of Privacy Practices directly from us at any time. We are required by law to maintain the privacy of your health information and to provide you and your representative this Notice of Privacy Practice. We are required to practice the policies and procedure described in this notice but do reserve the right to change the terms of this Notice. If we change our privacy practices, all patients will receive a copy of the revised Notice.

Complaints: Express complaints to us, or the Secretary of Health and Human Services if you believe your privacy rights have been compromised. We encourage you to express any concerns you may have regarding the privacy of you information. Please let us know of your concerns or complaints in writing and address them to our Patient Advocate so that we may undertake the proper procedures to remedy the situation as quickly as possible.

Patients and their legal gaurdians have the responsibility to:

Provide complete and accurate medical, health, and insurance carrier information.
Remain under the care of your physician while receiving therapy services.
Keep your appointments or call to reschedule with 24 hr notice: (270) 688-4889
Accept the responsibility for any refusal of treatment.
Ask questions when you do not understand information or instructions.
Treat staff with courtesy and respect.
Contact our office in the event of change of address, phone, or insurance information: (270) 688-4889

Insurance & Payment Options

Insurances We Accept:

Aetna US Healthcare
Anthem
Assurant Health
Aultra Administrative Group
Benefit Administration Systems
BlueCross BlueShield
Bluegrass Family health
CBA (Cooperative Benefit Administrators)
Cigna
Comprehensive Benefits
Consecrate Group
Coventry Cares of Kentucky
CWI Benefits
D H Evans & Associates
EBC
Ecom PPO (Cooperative Benefit Administrators)
EPSDT
Humana (ChoiceCare, Medicare Advantage, CareSource)
INETICO, Inc.
Kentucky Health Cooperative

When Maliyah first came to TheraTree she was very shy. She would provide one or two word answers during sessions when her therapist initiated the conversation, would hesitate to talk when others were around, and she would wait to ask for help until after her therapist offered. Now, when she arrives for therapy, she is excited to tell her therapist about the stuff she did during the week, reciprocates in the conversation for at least 10 minutes, and asks for help without any hesitation. Through encouragement and support, Maliyah is coming out of her shell and she is gaining more confidence every step of the way! We are so proud of you and your progress!

Medicaid
Mertain
North American Administrators
Owensboro Community Health Network
Passport Health Plans
Pittman & Associates
Preferred Health Plans
S & S Healthcare Strategies
The Health Plan
Tri-Care Health Net Federal Services
United HealthCare
WellCare of Kentucky
Wells Fargo/HealthSmart Solutions Ins.

If you haven't met your deductible, or have other out-of-pocket expenses, we accept the #CareCredit credit card to help bridge the gap between insurance and the cost of care.

Don't see you insurance company? Don't worry! We accept many other plans and are willing to credential with new insurance companies. Call us to discuss your plan: 270-688-8449

Not Ready?

FREE Developmental Checklist

Check now to see if your child is meeting their developmental milestones.

Use our interactive screening tool to see if your 1-6 year old is on track with their gross motor, fine motor, speech, and sensory skills.

Start Developmental Checklist

FREE Screening

All screenings are FREE of charge and last about a fifteen minutes.

The purpose of a screening is to find out if there are areas of concern that need evaluation. If the screening identifies that your child presents with red flags that are not developmentally appropriate, it will be recommended to complete a comprehensive evaluation.

Request a FREE Screening

⭐️ Milestone Moment ⭐️

I started seeing Jasper on a few short weeks ago. In less than a month, I have seen so much progress! Today was the first session that his mom or grandma didn't have to stay with him longer than just to drop him off and pick him up. Jasper has struggled to play without throwing or destroying items, as well as showing variety in play. Today, Jasper independently initiated playing with 11 toys or games, and played with all of them appropriately. He had so much fun and is making so much progress in such a short time.

Privacy Practices, Patient Rights, Grievances

PRIVACY PRACTICES

Therapeutic medical treatment and quality of care are one of our highest priorities. We are committed to the privacy rights of our patients and their families. We are required to provide you with this notice of our legal duties and privacy practices required to maintain the privacy of protected health information. We are required to abide by the terms of this notice currently in effect. We reserve the right to change the terms of our notice and to make the new notice provisions in effect for all protected health information that we maintain. If we do update our notice, we will post a revised notice on our website. You may also request a copy of any revised notice by calling the office and requesting that a revised copy be sent to you in the mail or by asking for one at your time of you next appointment.

Health Insurance Portability and Accountability Act (HIPAA): HIPAA is a federal law published by the US Department of Health and Human Services (45 CFR Part 160 and Subparts A and E of Part 164) in 1996 that sets national standards for protecting sensitive health information. It requires health care providers, including TheraTree, LLC, to safeguard patient Protected Health Information (PHI). TheraTree will notify affected individuals as required by law if a breach occurs that may have compromised the privacy or security of protected health information. HIPAA gives parents and guardians rights over their child’s health information, including the right to access records, request corrections, and understand how information is used or shared. TheraTree, LLC follows HIPAA regulations to keep patient health information private and secure.

Personally Identifiable Information (PII): Any information that can be used to identify your child or your family, either on its own or when combined with other information. Examples include name, address, phone number, date of birth, email address, Social Security number, or photographs and recordings that show identity.

Protected Health Information (PHI): A subcategory of PII that relates specifically to health care. PII becomes PHI when an individual is identified and connected to an their health information. PHI includes any information that identifies your child and relates to their past, present, or future physical or mental health, the care they receive, or payment for health care services. Examples include medical records, therapy notes, diagnoses, test results, treatment plans, and health insurance information. Both PII and PHI are protected by federal and state privacy laws, and TheraTree, LLC safeguards this information in compliance with HIPAA and applicable regulations.

HOW YOUR HEALTH INFORMATION MAY BE USED
PHI will be used and disclosed as part of rendering care for treatment, payment and, healthcare operations. Access to health information is limited to clinicians involved in care, authorized administrative personnel for billing and compliance, and payer or government auditors when required by law. Federal and state privacy laws permit the use or disclose your PHI without obtaining consent or without giving you a chance to object or agree with the use or disclosure in the following circumstances:

Provide Therapeutic Services: We will use your health information within our office to provide, coordinate, or manage your care . This may include administrative and clinical office procedures. Because we believe students are the future for providing quality services to our patients, student clinicians, assistants, and interns on our team will have access to your health information, observe, and/or lead treatment. Although volunteers in our volunteer program do not have direct access to health records, they are present in our facility. All students and volunteers have completed HIPAA training and signed HIPAA agreements. We may share your health information with referring physicians/pediatricians/therapists or other health care personnel providing your treatment. TheraTree may disclose protected health information to business associates that perform services on our behalf when permitted by HIPAA. Business associates are required by applicable law and contract to appropriately protect the information they receive.