Does Health Insurance Cover Speech Therapy?
Your health insurance plan may cover speech therapy, although each policy has its own set of specific stipulations. Your plan may also have strict limits on the amount of coverage it provides and a specific set of regulations you must follow to be eligible.
Additionally, the Children’s Hospital of Philadelphia says that many health insurance policies readily provide coverage for evaluations to determine if you or your child could benefit from speech therapy. When it comes to actually covering the therapy itself, however, many policies are not as generous.
What stipulations might apply to be eligible for speech therapy?
Insurance plans are likely to require you first set up a speech-language evaluation to determine if you need speech therapy. Your insurance company may require a referral from your primary care doctor or other healthcare professional before it grants the evaluation.
You may additionally need a referral for a speech therapist and possibly pre-certification from your insurance company before you even set up your first therapy appointment. Your health insurance company may have a network of speech therapists with which it works and going outside the network may mean you pay for a larger part or even all of the therapy out of your own pocket.
You also want to find out if you have to meet a deductible before speech therapy coverage kicks in. Your insurance company may have a maximum number of visits you’re allowed for speech therapy each year and it may require you to schedule all those visits in advance or at least within a set time frame.
What does speech therapy do?
The goal of speech therapy is to address issues that people may have saying particular words or sounds and then correcting those issues so individuals can be better understood. KidsHealth.org outlines a number of specific conditions and disorders that may benefit from speech therapy. These include fluency, articulation, resonance, and language disorders.
Stuttering is one of the more common conditions. It falls under the fluency disorder category. Fluency disorders involve issues with saying a complete word or specific sound.
Lisps are another common condition. These fall into the realm of articulation disorders. Articulation disorders come into play when people have problems saying sounds or words correctly, such as pronouncing “lisp” as “lifp.”
Those who are difficult to understand because of a highly nasal tone of speech or mumbling may have a resonance disorder, also known as a voice disorder. Language disorders can cover a lot of issues when people have trouble speaking in sentence or phrases that express an idea or thought.
People of all ages may end up needing a speech therapist for a number of reasons, and the therapy is especially widely used to help kids. People suffering from health or medical conditions may have issues with their speech, particularly those who have hearing impairments or a cleft lip or palate.
Autism can often result in speech impairments, as can breathing or swallowing disorders. People with weak muscles in the mouth area may benefit from speech therapists and the therapy may also help those who suffer from hoarseness caused by nodules on the vocal cords.
What happens at a speech therapy session?
The first order of business for a speech therapist is usually to give you a speaking test. The therapist will listen and take note of any issues you have with certain sounds or words in order to determine the type of speech issues you may have. This helps him figure out what type of treatment would be most beneficial.
Once specific issues with words and sounds are noted, the therapist then illustrates by example the proper way to form the words or sounds. You might use a mirror to ensure your own mouth area is following the same movements as the therapist’s. You may also be introduced to supplementary diagrams, models, or materials to illustrate the movements in greater detail.
Your job as a patient is to practice as often as you can. You want to repeat the words and sounds until the correct movement of your mouth area becomes habitual and the sound is produced in a manner that people can understand. The effectiveness of your speech therapy largely depends on how frequently you practice.
The length of treatment can vary widely. Those with mild disorders who are quick to learn and eager to practice may complete treatment in a relatively short amount of time. Those with language disorders or more severe issues may need sessions over a period of months or longer.
What if my insurance company denies speech therapy coverage?
If speech therapy is part of your plan benefits yet the insurance company still denies your request for coverage, you can file an appeal. Make sure you have a copy of what is covered under your specific plan as well as a copy of the denial in writing.
Just as your insurance company may have had strict stipulations when it comes to granting coverage, they may have equally strict stipulations for appealing a denial. Find out what they are and follow them to the letter. You may want to supplement your case with a letter from your primary care physician, speech therapist, and other professionals who indicated speech therapy is a health or medical necessity to improve the quality of your life.