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Obtaining Reimbursement for Stuttering Treatment

The information below explores what factors need to be accounted for when trying to obtain reimbursement for therapy from an insurer.

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Does my health plan cover the cost of treatment around stuttering?

When you enroll in health insurance, the insurer is required to give you the plan policy outlining the coverage for the monthly premiums. It will be important to understand first what coverage you have in that plan. These documents can sometimes be difficult to search and find the coverageIt will be important to find the words around “speech therapy” or “speech language pathology” to determine what the coverage might be. It is always the best decision to confirm what the policy states in your own words with a representative from the insurance company.  
There are some things that you will want to take into consideration when understanding coverage. Some insurance plans might cover a certain number of visits. You will want to have the insurance company provide written documentation of this limit. Insurance might have a co-pay, deductible, or other payment limits that you need to have in writing. Knowledge of these limits will allow you to understand what visits you might need to find other form of payment assistance for.

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Are there pre-requisites I must meet before an insurer will cover speech therapy?

A pre-approval might be needed to get treatment for an individual.  If you plan to use a speech therapist that accepts insurance, they should be contacting the insurer to check if your coverage requires a pre-approval. That will depend on the insurance policy and/or the practitioner. If an approval is required, your Primary Care Physician might need to see you to evaluate and determine if a prescription is needed for speech therapy. This step will occur before the speech language pathologist even gives you an evaluation for treatment.

Then, the insurance company will likely require some communication from the speech language pathologist. There will need to be the diagnosis of treatment with all the applicable codes (see the common types of codes in the next section) that will be billed for the treatment. A Care Plan will help the insurer understand frequency of visits, cost of therapy, and the length of time the individual will plan to have therapy.
 

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Common Types of insurance codes for Coverage Inquiries

When calling your health insurance company, it is useful for you to have some codes that the representative can use to look up possible coverage for types of stuttering treatment.  Below are a few of the most common Diagnosis and Procedure codes used by Providers and Insurers.

These codes are a starting place for you to be able to understand some possible choices from an assessment. Your healthcare provider should know and identify the best diagnosis and procedure codes to use in your particular case.
A great resource for the most updated codes related to stuttering can be found through the American Speech-Language-Hearing Association’s resources (https://www.asha.org/practice/reimbursement/private-plans/reimb_stutter_trtmnt/).

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