Doctor Referral Needed
Even though you realize that your child needs help, and the teacher of your child thinks the same way, a diagnosis by a doctor is required for your child, which implies that your child needs speech therapy. This could be achieved via a written-out prescription received by your doctor so that your child could start seeing a speech therapist. Not all insurance companies agree. For example , speech therapy to improve stuttering or a lisp may not be included in your coverage; however, your insurer may consider speech therapy as a necessity for the treatment of a voice disorder.
Insurance companies will not pay for services to change your accent. This is because an accent is not a speech or language disorder. You will need to speak with your SLP about how you can pay for services. To find a speech-language pathologist near you, visit ProFind.
Refer to Service Delivery
Provider refers to the person offering the treatment. Accent modification services can be provided by SLPs, English as a Second Language instructors, voice and speech coaches, and other professionals.
Format refers to the structure of the training (e.g., group and/or individual). Accent modification can be delivered individually, in a small group or online.
Setting refers to the location of services (e.g., home, community-based, work). Services can be provided in an SLP’s office, in the individual’s home, or online.
Dosage refers to the frequency, intensity, and duration of service. Many accent modification programs may be intensive in nature. Dosage is determined on the basis of each individual’s specific needs.
Why is insurance denying speech-language services
Reasons for denying or limiting coverage vary depending on the case. Insurance companies are required to provide a written response outlining their rationale. Here’s a few of their most common objections:
Treatment is ‘not medically necessary’
Speech-language therapy is not a covered service
Local public school provides services
Treatment is educational/developmental in nature
Insurance Plans That Cover Speech Therapy
Blue Cross Blue Shield (BCBS) companies have been among the biggest insurance providers in the US. In every state and zip code, Blue Cross Blue Shield offers healthcare, this can vary based on where you live. In some states, Blue Cross and Blue Shield are two separate health insurance companies with large networks. A main differentiation for BCBS is that they also offer plans that cover dental, vision and prescription drugs as well as cover your health needs.
Kaiser Permanente is the largest managed healthcare institution in the US that operates in a total of eight states which are Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia as well as the District of Columbia.
Cigna provides coverage for speech therapy; however, the levels of coverage differ in each plan they offer. If the plan you have covers speech therapy, then you should provide the necessary evidence and your child should demonstrate some betterment with the therapy, which is expected by the insurance company allowing them to know that the therapy serves its purpose and the child show some improvement, so they do not provide the cost of the therapy uselessly, and unnecessarily.
Tricare presents coverage for speech therapy if the child’s speech problems arise out of birth defects, developmental disabilities, disease, or injury. Therefore, not all children with speech problems are entitled to receive the therapy they need in which the expenses are met by their families’ insurance plans.
Medicare helps you pay for the sessions of speech therapy, but there are some requirements that need to be met. First off, you have to pay 20% of the cost of each session, and for Medicare to help you with payments, you should pay the amount of money for the health services coverage, so that your insurance plan starts to pay for the facilities. Therefore, meeting your deductible is important.
There are other insurance plans that are common across the USA. If you have one of these plans, you can contact the customer service to learn if your plan offers coverage for speech therapy services, and their phone numbers are usually placed on the back of your health card. Some of these common insurance plans are;
If your plan is to use your coverage for the payment of speech therapy services, do not wait to contact your insurance provider until the end of your first session of the therapy. This may cause you to have to pay the total bill when the time comes. Instead, prior to the first session, talk to your insurer to make sure that they approve the type of insurance plan you have, and then contact the insurance company to learn how much of the bill you will be paying.
Additional Sources for Health Care Assistance
If your insurance plan does not cover speech and hearing services, there are other alternatives in terms of health care assistance;
Schools - Individuals with Disabilities Education Act (IDEA) is recognized as a legal landmark that provides a federal grant to children with disabilities. It enables your child to receive such services through their public school.
Hearing - There are many organizations that could help with audiology services and hearing aid expenses, such as deaf community centers, hearing aid banks, speech and hearing centers, and child health centers.
Speech / Language - There are various organizations that could help with expenses regarding speech-language pathology services and with assistive technology. ( Assistive technology refers to equipment that improves learning, functioning, and also daily life of individuals with disabilities).
A Federal Program: Medicaid
Medicaid is the social security run by federal authorities, and its purpose is to help people who seek health care but are unable to afford it. To benefit from Medicaid, you or your family have to meet the financial benchmarks that have been set by the authorities. If you fail to meet these requirements, you might be expected to provide evidence of the family member with disabilities which makes them eligible for Medicaid. Medicaid considers autism a disability, and if the family member with disabilities is deemed qualified, then the person with the disability can receive the help and treatment that they need. Contrary to the popular belief, Medicaid is still considered high coverage insurance by professionals. Usually, each state pays for the services received by the people via Medicaid and is qualified for it. Parts of the population that the states are obliged to cover:
Children coming from low-income families aged up to 18
Pregnant women coming from low-income families
Caretakers or parents from low-income families
People or seniors with disabilities getting cash benefits from the supplemental security income program
Application for Medicaid as of 2021
There are two ways to apply for Medicaid in your state, where the process of application is still the same in 2021 with 2020. Regardless of your choice of application method, you are expected to provide information about your salary, medical (health) history, and family ties.
You can apply for Medicaid through:
1. The Health Insurance Marketplace - It is basically a website where you can make the insurance payment, which is granted by the federal government. You can make the application online from the website; however, you are obligated to answer questions. After this process, you can see whether you are entitled to get an insurance plan or not.
2. Your State Medicaid Agency - You can communicate with the Medicaid agency that is within your state if it is not convenient for you to use computers to complete the essential forms. The Medicaid agency could inform you about whether you are qualified for the insurance plan or not.
There are families who are not eligible for Medicaid but still need financial support. If you use the first option of application, which is using the website, and you need financial support but are not eligible for Medicaid, that will be figured out after your application. There are other insurance plan options to choose from that are suitable for you on the website.
PLEASE NOTE: Being deemed eligible for Medicaid after completing a marketplace application means that you will not be qualified for a subsidy to buy a private plan . It means that at this point, you would have to choose whether to enroll in the government plan or instead purchase a private plan at full price.
Limitations of Medicaid
Medicaid covers the majority of your healthcare expenses. However, there are some limitations to it that families should be aware of. These limitations include:
We Can Help!
The cost of speech therapy often depends on many things, and it differs all across the country. So, how much you should put aside to pay for care is based on a number of things including:
The type of insurance coverage you have - Not all insurance plans agree on what is medically necessary that should be included in the coverage or not. For example , speech therapy to improve stuttering or a lisp may not be included in your coverage; however, your insurer may consider speech therapy as a necessity for the treatment of a voice disorder.
Your place of accommodation (where you live)
Whether you consider using your insurance coverage to pay for the care or not.
The place where the services will be provided - The cost of therapy is affected by the location and the place that it takes place. There are three different ways for it, which include:
1. Home visits
It is the most expensive option because the therapist comes to your home for therapy sessions. This means that you have to pay for the health care staff’s travel expenses. However, your child will be in a comfortable environment, which is an advantage.
2. Office visits
The therapy sessions are held at the therapist’s office. It is time-consuming because of the time spent on the way when you drive your child to the therapist’s office. However, it is less expensive than the home visits option.
It is like online therapy, where the therapy sessions are held via video calls. However, it is important to note that not all children are able to benefit from online therapy. *So, in-person therapy sessions may be needed if you believe that your child does not get the benefits from online therapy sessions. *