Questions you should ask your Insurrance Provider

When contacting your insurance about speech therapy coverage, key questions to ask include: does your plan cover speech therapy, what is the required diagnosis for coverage, are there any limitations on the number of sessions, do you need a referral or prior authorization, what is your copay or coinsurance, and are there any specific exclusions or conditions for coverage; also inquire about in-network providers and if coverage applies to different therapy settings like home or school.

Specific questions to ask:

• Basic Coverage:  

 • Does my insurance plan cover speech therapy?

 • What diagnostic codes are covered for speech therapy?   

 • Is a referral or prescription required for speech therapy services?

• Cost and Payment:  

 • What is my copay or coinsurance for each speech therapy session?

 • Do I have a deductible that needs to be met before speech therapy is covered?

 • What is the maximum out-of-pocket cost for speech therapy per year?

• Session Limits:

 • How many speech therapy sessions are covered per year under my plan?

 • Are there any limitations on the duration of each therapy session?

• Prior Authorization:   

 • Do I need to get prior authorization for speech therapy services?  

 • What is the process for obtaining prior authorization?

• Provider Network:   

 • Do I need to use an in-network speech therapist to receive coverage?   

 • Can you provide a list of in-network speech therapists in my area?

• Specific Conditions:   

 • Are there any specific diagnoses or conditions that are excluded from speech therapy coverage?

 • Does my plan cover speech therapy for developmental delays or other specific needs?

• Therapy Settings:

 • Does my insurance cover speech therapy provided in different settings like a clinic, school, or home?

Important Considerations:

• Review your insurance plan details: Always check your insurance policy or benefit booklet for the most accurate information about speech therapy coverage.

• Ask about specific codes: Find out the correct ICD-10 diagnosis codes and CPT procedure codes associated with your speech therapy needs.

• Contact your speech therapist: Discuss your insurance coverage with your chosen speech therapist to ensure they are in-network and can properly bill your insurance.