A very common question that we get is, “Is speech therapy covered by insurance?” While there is a process to submitting claims and determining speech therapy eligibility, every plan offers different benefits. While the process to determine eligibility may seem like a chore, any opportunity to take advantage of your insurance plan is worth looking into–particularly when it comes to the needs of your family.
In this blog, our hope is to give you a better understanding when it comes to your child’s speech therapy eligibility. Insurance coverage seems to always be a complex topic, and with speech therapy, there is certainly no difference. Every insurance company is different and every person’s line of coverage is different. For instance, some insurance companies require pre-approval, some require a referral from another doctor, and some have unlimited benefits. And while these factors may differ for everyone, one thing is for sure: there is no linear plan for every family.
That being said, speech therapy is frequently a covered benefit when a patient has an acute illness or injury that requires rehabilitation. Additionally, if a child is born with a cleft palate or lip, speech therapy is usually covered by insurance. This also applies to traumatic brain injury (TBI), stroke, and more. Typically, when speech therapy is necessary due to a tragic event, then speech therapy is often a covered benefit.
Many insurance companies exclude developmental or chronic disorders. For instance, when a child has a speech delay, lisp, or another type of articulation disorder, then their therapy may not be a covered benefit or the coverage may be limited.
Determining if Speech Therapy is Covered by Insurance
Whatever the case, the next best step in determining eligibility is to always check with your insurance company. Additionally, when assessing your health plan, here are some important factors to consider when determining if speech therapy is covered by insurance:
- Benefit limitations: While the type of coverage you have may offer reimbursement for speech therapy, there may be a cap on your benefits. This means your insurance company may cover a certain number of speech therapy sessions, or a certain dollar amount in speech therapy (for example, $1000 total). When this happens, there may be an annual cap of benefits for the total amount allowed for one beneficiary.
- In-network insurance: Many insurance companies have a number of “in-network” providers, which means that they may bill your provider on your behalf; however, this does not mean that your therapy will always be covered by your health plan.
- Out-of-network insurance: Some health plans may allow you to see “out-of-network” providers and offer reimbursement of some or all costs from those out-of-network or private providers. Keep in mind that out-of-network benefits are often associated with PPO plans. While this may allow you to see a provider of your choice, it may require you to pay a deductible before you are able to use any of these benefits. It is always best to call your insurance company and ask if you are eligible for these benefits and find out exactly what the terms are for your plan.
- Benefit exclusions: It is always important to take a good look at the exclusions of your coverage plan. It is also always good to review your plan’s exclusions (if any) after your initial speech therapy consultation.
If you are considering speech therapy, contact our team for an initial consultation!
Contact Our Team of Speech Therapy Experts
Finding a highly qualified and trusted team of speech therapy experts who will be able to address your particular needs can often feel like an overwhelming task. However, our team is here to make the process as easy and transparent as possible. Not only that, but we also specialize in a wide range of speech therapy needs, so you can feel at ease when it comes to entrusting our team no matter what issues you are facing.
With years of experience helping children and adults improve their speech, we are dedicated to providing thoughtful, patient-oriented service. Our team is here to help you and your family from start to finish, ensuring exceptional results that you can count on.
At LA Speech Therapy Solutions, you can count on our experienced team to be there for your family every step of the way. We understand the importance of providing the best possible speech therapy and we take pride in what we do. If you are unsure if your speech therapy is covered by insurance, contact us so that we can guide you in the right direction or you can contact your insurance company directly. Whatever your situation is, we offer a 15-minute complimentary consultation with an experienced and qualified team member at one of our locations in South LA, Silverlake, or San Gabriel Valley. Contact our team today!
