The world of insurance can be a complicated place. Knowing what is covered and what isn’t can be very helpful when exploring speech therapy options. We’ve compiled the 10 top questions often asked when dealing with insurance plans.
1) What codes are covered in your plan?
When speaking with your insurance provider, there are two different types of codes you may want to discuss. The first is the diagnosis code also referred to as the ICD-10 code. There are many diagnostic codes your therapist may use but some examples of an ICD-10 code include: F80.0 Phonological Disorder, F80.1 Expressive Language Disorder, and F80.2 Mixed Receptive-Expressive Language Disorder.
The second code is the treatment code also called the CPT code. Again, there are many codes available for use, but a couple examples could be: 92507 treatment of speech, language, voice, communication, and/or auditory processing disorders (individual), and 92609 therapeutic services for the use of speech-generating device, including programming and modification.
It’s important to speak to your speech-language pathologist (SLP) to determine which codes apply to you/your child.
2) How many visits are you eligible for per year?
Some insurance plans limit the number of speech therapy visits allowed per year. Some also lump together speech therapy, physical therapy, and occupational therapy and have you divide the allowed number between the 3 disciplines (if all are needed). It’s important to know how many visits your insurance will cover and if they lump speech therapy in with other therapies.
3) Are out-of-network providers covered by my insurance?
Out-of-Network providers are providers that do not have a contract with your insurance company. Some insurance companies will cover most or all expenses incurred while seeing an out-of-network provider. However, some insurances will cover minimal to no expenses for out-of-network providers. This is something that could greatly impact your out-of-pocket expenses for therapy and is worth looking into when deciding what provider to choose for services. We are always happy to request a contract with your insurance company if we not already in-network.
4) How do I find in-network providers?
Check your insurance company’s website or give member’s services a call. They will help you find providers that have a current contract with your insurance plan.
5) What is a Superbill?
A superbill is an information sheet detailing the services you have received from our company. This is prepared by your provider and is the form you will submit to your insurance company for possible reimbursement for services. This a popular option for many clients using our services as out-of-network providers. Calling ahead and asking if your insurance allows for reimbursement will help you plan financially for your services. Our providers are available to help you through this process.
6) Do I need a doctor’s order to get services?
Some insurances do require a prescription or referral for services. Many families are able to call their doctor to request a referral/prescription for speech therapy. Some doctors may ask to see the patient before writing a script. This is something we can help with by coordinating with your pediatrician.
7) What are my co-pay amounts?
Most insurance companies require co-pay amounts like you would have at the doctor’s office. The amounts can vary and calling your insurance company will help you understand what you are responsible for paying per session.
8) Are speech therapy services eligible for HSA reimbursement/payments?
Speech therapy is usually eligible for reimbursement with flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA). I recommend you contact the administrator of your HSA or FSA to confirm that your child’s specific services are covered under the terms of your account.
9) Is therapy covered at various locations (e.g. school, home, clinic)?
Some insurance companies will only cover therapy that takes place in an outpatient center. Others will cover home health and community centers. Knowing this information can help decided where to seek services.
10) What if services are denied?
In some circumstances, therapy coverage may be denied even if your policy states they are a covered expense. In this case, you have the option to appeal the decision. Our providers will give you the information you need to start this process, collaborate with your pediatrician to obtain prescription information and referral documentation, and provide necessary speech therapy documentation.
A few important points to remember:
· If your insurance changes for any reason be sure contact us with your updated coverage.
· Every insurance plan is different, knowing the details in your specific plan will help you navigate the financial side of therapy services.
Our providers are here to walk you through the insurance process and answer any questions you may have. Contact us today to set up a visit or consultation.
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