Insurance
Out of Network?
Not in Network?
Follow the steps below to determine if speech therapy is covered for you as an out-of-network service:
1
Call the customer service line of your provider. You will be asking for coverage details on 'rehabilitation', 'speech therapy', or 'speech-language pathology.'
2
If you are covered under your insurance, ask your provider to clarify any exclusions or limitations to coverage, including number of visits, coverage of the evaluation, and coverage of the treatment sessions.
3
Ask your insurance representative to clarify any additional requirements for approval and coverage, which may include a physician order, pre-authorization, an evaluation conducted by a speech-language pathologist, and/ or a progress report, among other items. Be sure to ask your rep how you will submit the documents once you have them.
4
Directly contact:
-Your primary physician
- Our office at St. Mark's
From each office, request the appropriate documents listed by your insurance representative. Once you have these documents, submit them to your insurance provider as instructed by your representative.
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We Accept the Following Providers:
Denied Coverage?
Various insurance companies or individual plans do not cover speech therapy services, particularly for children. This may be due to your child's diagnosis - if the diagnosis was present from birth (ie., autism, developmental delay, stuttering, cleft palate, congenital disorder, etc), speech services may not be covered, as your insurance company views this disability as your child's 'normal baseline', even if it is negatively impacting their daily, functional abilities. However, if the disability is due to "accident, illness, or injury'" then your plan may cover services.
Your insurance may also deny coverage if the child's diagnosis affects their academic performance, and assumes that the child qualifies for speech therapy through their school. Unfortunately, your child may not qualify for school-based speech therapy services unless it directly and negatively affects their ability to make academic progress.
If this is the case, payment for speech services can be made privately via check, credit card, or cash. We can also provide a Superbill as a means to assist you in potential reimbursement from your provider (see below). Please contact our office for further details.
If you are out of network and unsure if your plan covers speech therapy, you may be able to receive partial or total reimbursement from your insurance provider after you have paid 'out of pocket' for services rendered. If you would like to pursue potential reimbursement, our office will provide you with an itemized 'receipt', or invoice, of services, which contains information such as diagnoses, treatment codes, and other essential details needed for billing and reimbursement.
This receipt is called a 'superbill', and can only be provided after payment has been made for services. Once you have the completed superbill form, you can then submit it to your insurance provider. It is then up to your provider to decide if they will reimburse you for full amount that you paid, partially, or not at all. It is completely dependent on your particular provider and plan. However, if your claim is denied, it can be appealed, and denials are occasionally made due to small, technical errors on the document. Our office is always happy to help with this process!
What is a Superbill?
Contact
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