Will Insurance Cover Speech Therapy?

Will Insurance Cover Speech Therapy?

The answer to the question of insurance coverage for speech therapy is unfortunately, “it depends”. The good news, though: there are many types of speech therapy that are covered by most health insurance plans.

Here’s what you need to know about insurance coverage for your child’s speech therapy:

Check With the Source:

We always recommend starting with the source: your policy language. You can find your full insurance policy through your online account or via your company’s HR department. If you have trouble identifying exactly where to locate the policy language on speech disorders, call the number on the back of your insurance card and ask a representative to send you the applicable sections.

This is one time when you really do need to read the fine print, so grab those reading glasses and dive in!

Common Coverage for Speech Disorders:

Many plans say they cover speech therapy for “medically-necessary speech-language pathology services.” Of course, “medically necessary” is in the eye of the beholder – or the opinion of the claims adjuster.

Health insurance will commonly approve speech therapy coverage for the following reasons:

–> Speech difficulty due to a stroke or head injury
–> Swallowing or feeding disorders
–> Voice disorders caused by anatomical anomalies, neurological disorders like Parkinson’s, or injury
–> As part of comprehensive coverage for autism spectrum disorders

Of course, this is not a complete list, and coverage can vary wildly between companies and individual policies. Always check on the details of your particular plan.

Common Reasons Insurance Companies Deny Coverage:

Insurance companies are notorious for denying claims first, asking questions later. If you get that initial denial, don’t panic. Just be aware that you may have to make a lot of phone calls to make and paperwork to write up.

Here are some of the main reasons we see insurance companies deny coverage for speech-language therapy:

–> Common speech sound or language delays
–> Services considered “educational” or taking place in an educational setting
–> The benefit plan only covers speech disorders resulting from “accident, injury, or illness” – in other words, a child born with developmental delays or disorders may not qualify unless a “triggering event” can be identified

What to Do If Insurance Denies Speech Therapy Coverage:

If insurance denies coverage for speech therapy, you have options!

  1. Call your insurance company and request the specific reason your claim was denied. Document who you spoke with, the date and time, and definitely request the reason for denial in writing. Ask about the appeals process, and get that in writing as well!
  2. Recruit help from your HR department. You can pass information along to your benefits coordinator who can then contact the insurance company on your behalf.
  3. Request a letter and/or referral from your child’s pediatrician. Ask them to emphasize the medical necessity and the benefits of therapy for your child.
  4. If you already have a relationship and/or treatment with a speech therapist, ask them to provide documentation on the necessity of therapy, a recent progress report and a detailed plan of action to address the problem. Many times, insurance companies want to see that there is a fixed timeline to treat the problem rather than an expectation of ongoing services over several years.
  5. Follow your insurance company’s appeal process with as much diligence as possible, and keep following up! You know what they say about squeaky wheels, right?

What if Speech Therapy Isn’t Covered, Even After the Appeals?

If your health insurance ultimately does not cover speech therapy, there are still affordable options for you. Many practices offer prompt-pay discounts, and online speech therapy is sometimes more affordable. Your local school district’s special services department or your pediatrician’s office may also be able to point you to lower-cost speech therapy practices in your area.

Need help finding a speech-language therapist for your child? Search our comprehensive database to locate providers near you.

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