Will Insurance Cover My Child's Speech Therapy?
Could there be anything more confusing than health insurance? Insurance plans vary widely from family to family (and year to year). It can often be hard to understand if your policy will pay for your child’s speech therapy and how to submit your claim for reimbursement.
The best way to determine what your policy covers is to call up your insurance provider and ask the following questions.
5 Questions to Ask Your Insurance Company
Is my child eligible for speech therapy?
This is the first question to ask your insurance provider. Make sure you provide your child’s age as well as any diagnosis your child may have.
Your insurance company may only reimburse for certain treatments. For example, Blue Cross Blue Shield of Alabama’s medical criteria for coverage is usually limited to communication impairments due to disease, trauma, or congenital anomalies. Language therapy for young children with natural dysfluency or speech errors that BCBS considers “self-correcting” may not be covered.
Lastly, some insurance plans don’t cover speech therapy for children above certain ages (often 9), so be sure to check any age limits with your provider.
Do I need to obtain a prescription or pre-certification for therapy from a pediatrician?
A quick trip to your pediatrician may be needed before an insurance company is comfortable reimbursing therapy expenses. If you do need a prescription for therapy, explain your concerns to your child’s pediatrician and request that they provide a prescription to satisfy your insurer’s requirements.
It’s important to mention that you do not need a prescription to receive services from Steel City Speech. We’re happy to work with any parent who may have concerns about her child’s speech and language!
How are out-of-network services treated under my policy?
Steel City Speech is an out-of-network provider, which means that we don’t file and bill insurance claims directly with any insurance companies. But that doesn’t mean your insurance company won’t reimburse for out-of-network services! Ask about your insurance policy’s benefits for out-of-network providers, specifically:
What rate are out-of-network benefits reimbursed?
For example, if your insurer covers 90% of eligible charges after meeting your deductible, you would be responsible for any payments until your deductible is met, and 10% of payments afterwards. Keep in mind that there may be a difference between the actual charge your out-of-network provider bills you and the “eligible” charge that your insurance company reimburses.
Are there separate deductibles for in-network vs out-of-network benefits?
What documentation is required?
When you’re ready to file your claim, your insurer will require documentation from the therapist. Often, this information can be found on the medical expense claim form you will use to submit your claim (ask your insurer to provide this form or check their website for it).
At Steel City Speech, we provide a bill describing exactly what services were rendered, ICD-10 diagnosis codes specific to your child’s diagnosis, charges and CPT codes for each treatment, as well as detailed office notes.
And of course, we are more than willing to provide any other information your insurance company needs.
How long / how many therapy sessions are allowed?
Many insurers set limits on the number of sessions or months that therapy will be covered, such as 30 visits per year. However, keep in mind that many insurers count all types of therapy (speech, occupational, physical) towards this limit, so be sure to check with your insurer if your child is receiving other types of therapy.
You can do it!
Having your child’s speech therapy covered by insurance may seem like a daunting challenge, but taken step-by-step, the hassle may be well worth it. By asking your insurance provider the questions above, you can better understand how your policy covers your child’s speech therapy.
Don’t let insurance prevent you from providing your child with the support he or she needs. We’re here to help you each step of the way. Speak with us today!