Speech Therapy and Health Insurance. What you Need to Know.

You want to be prepared as much as possible for medical issues, illness, injury, or permanent disability which can leave you and your family facing great emotional stress. That’s why you must think about having comprehensive health insurance for your family. This will not only help avoid financial stress but also help you focus on recovery and getting the support you need to get better.

Will Insurance Cover Speech Therapy ?

You might be thinking, you’ve got everything covered by your health insurance but when it comes to speech therapy, dealing with the insurance company for reimbursement is a bit different and more complex. And sometimes, it can be a long or tedious process, with more negotiations and appeals. There are good reasons to choose an out-of network provider for speech therapy, but read on to get some more details.

In fact, most families also have not thought about their health insurance policy and if it includes speech therapy reimbursement and under what conditions. At Therapy Works Together, we offer families the opportunity to get treatment from experienced speech therapists who are experts in their field at an affordable rate. Read below to see why our speech therapy services might be even more affordable than going through your insurance.

For those families considering using health insurance to reimburse speech therapy, the first issue is to understand what your health insurance policy says about speech therapy benefits. If you are unsure about your benefits plan, contact your employer’s human resource office and ask for a copy of the plan or request an explanation of your benefits related to speech therapy.

Often, the benefits for speech therapy might be something like, “20 visits for Speech Therapy.”

There is a Problem: There are usually very specific conditions under which your health insurance plan will actually approve and pay for speech therapy visits.

These conditions (sometimes called exclusions) under which the insurance company will not pay for speech therapy, are rarely described on the health plan websites. Therefore, you must call your health insurance company to verify if they will cover speech therapy for your child.

It is important to know in advance some of the factors or reasons your insurance company might not cover Speech-Language Pathology services:

1. Your child might outgrow the issue on their own. Usual exclusions include language delay, language disorder, lisps, auditory processing disorder, stuttering. Why? Because insurance companies deem that kids may outgrow the issue on their own.

2. Your child can get therapy at school. Many plans deny services for school-age children because they can receive therapy in school. Unfortunately, not all children are eligible for school therapy unless the disorder is determined to be “educationally handicapping” (or very severe). In addition there could be long waitlists and big groups, both of which slow down your child’s progress.

3. No Medical necessity. Oftentimes if a child needs therapy but there is no obvious medical need such as a stroke, an injury like traumatic brain injury or a pre-existing condition (like Autism or cerebral palsy) they might also claim that covering speech therapy is unnecessary.

1. Under what circumstances does my policy cover speech therapy? Confirm the conditions that are covered and if there is an exclusion clause stating that therapy might only be covered due to accident/injury/illness.

1. Do I need a doctor’s prescription to get speech therapy coverage? Some insurance plans require your doctor to write a prescription for speech therapy. If you need a prescription, but don’t get one before starting speech therapy, the services may not be covered.

2. Do I have a deductible, copay or coinsurance? Even when there is coverage for speech therapy you may be responsible for a deductible, copay, and/or coinsurance. If you are responsible, how much are you required to pay?

3. How many speech therapy sessions are covered per calendar year? Unfortunately, many insurance plans have a limit on how many therapy sessions a person can get per year. For example, some plans restrict patients to 60 therapy visits during a calendar year, and some often group speech therapy, physical therapy, and occupational therapy together in those 60 visits. Ask for details.

Navigating the insurance process can be frustrating for families and there are unfortunately many restrictions to speech therapy coverage. This is why at Therapy Works Together we want to provide families with an affordable choice that provides them with experienced speech therapists who care about helping clients achieve the communication goals they’ve set out to master.

Affordable Speech Therapy Can Be Better for Families

Here are some reasons why:

1. Session rates are likely the same as your copay. If that is the case, why not choose services that offer flexibility for scheduling and selecting a speech therapist that is an expert in your needs (not just the one available in your area or the one with time in the schedule).

2. Have you met your yearly deductible? We might be cheaper in the long run. If you have a $6,000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $6,000 in out-of-pocket fees before your standard copay applies. That may not be worth it. And since clients tend to graduate from speech therapy faster than those going the insurance route, you may end up spending less in sessions with Therapy Works Together as opposed to an in-network provider.

3. You may have good out-of-network benefits. With good out-of network benefits, your insurance company may reimburse you as much as 80% of each speech therapy session fee. So in some situations, using your out-of-network benefits can actually be more affordable or comparable to your standard copay to see an in-network speech therapist.

4. You get personalized treatment that works better for your needs. When a speech therapist isn’t limited to providing services they can bill to an insurance company, they can be more creative in designing the perfect treatment plan for you. That means faster progress.

5. No waiting. It can often be very difficult to find a speech therapist who is in-network and accepting new clients. And when you do find one, there may be a very long waitlist to see that speech therapist. The speech therapist at Therapy Works Together tend to have more availability and greater flexibility in scheduling new clients.

6. Get the best speech therapist for your needs. The speech therapists at Therapy Works Together have more specialized skills and certifications. The in-network SLP that has availability in the schedule might not be the one with the experience or skills needed for you or your loved one. That may mean slower progress.

7. We provide you with a superbill for insurance. That is an itemized receipt with all of the needed codes (CPT and ICD-10) that insurance companies need to potentially reimburse you for speech therapy services. When you request one, we provide it.