Speech & Feeding Therapy
Health Insurance Summary

It is important that you review the speech and
hearing benefits information provided by your
health plan before you receive services.

Our therapy programs are personalized to address each child’s specific needs. Our licensed┬átherapists are standing by to answer your questions.

Plan Information

We work with most major insurance plans including Blue Cross/Blue Shield, Healthcare Partners & TriCare Insurance in support of our local military families.

Contact us for more details on our insurance plan credentials.

Health benefit plans vary widely depending on the benefits and coverage levels of your plan. Sometimes, the benefits information on your health plan can be confusing.

Remember, the benefits booklet you receive is merely a summary of benefits and not the actual contract language. You may need to carefully examine the policy itself to truly understand your health plan’s coverage and limitations. When in doubt check with your insurance provider to confirm your benefits.

Understand Your Benefits

Coverage information for speech services may be included under ” physical therapy and other rehabilitation services ” or “other medically necessary services or therapies

Coverage of evaluations and/or assessment are “testing” and treatment is “therapy” services for most speech disorders.
Limitations and exclusions are typically located in a separate section, and might be referred to as “Things We Don’t Cover” or “Exclusions to Coverage”.

Common limitations and exclusions include:

  • No coverage for speech or feeding disorders that have a developmental or congenital cause
  • Coverage for acquired disorders only or only for treatment that is restorative or rehabilitative
  • No coverage for certain disorders, such as stuttering and autism
  • A limit on the dollar amount that will be reimbursed for speech and/or hearing services
  • A limit on the number of speech or feeding therapy sessions that will be reimbursed
  • Coverage may also be limited to certain settings such as a hospital or clinic
  • No coverage for devices such as hearing aids or speech-generating devices

When in doubt, check it out! If you are unsure about the coverage your health plan provides for speech or feeding services, call the 800 number listed on your ID card and speak to a customer service representative. Request that they provide any clarification of your coverage in writing.

Remember to keep copies of all documentation, including date, time, and contact person!

Get Permission Before Your Visit

Your health plan may require that you obtain prior approval or that a physician “prescribe” speech or feeding services.

This may also be referred to as “pre-authorization”, “pre-certification” or “pre-determination”. Read on to find out the subtle differences between these three terms.

  • Pre-authorization is how the health plan verifies your coverage against the proposed care.
  • Pre-certification requires that you notify the health plan before undergoing certain diagnostic or surgical procedures. The health plan assigns an authorization number.
  • Pre-determination is a health plan requirement in which the provider must request confirmation from the health plan that the service or procedure to be performed is covered under your policy.

Every health plan is different, so you’ll need to call the 800 number listed on your ID card and speak to a customer service representative to determine what speech or feeding services need prior approval.

Unfortunately, prior approval does not always guarantee coverage. So, always check with your health plan before having any service performed.

Remember to keep copies of all documentation, including date, time, and contact person!

EDUCATION VS OUTPATIENT SERVICE MODEL

Children may have access to speech and feeding services through the school system as well as through the medical system. Each system, however, has specific policies.

For example, school systems provide speech services only to children who qualify under a very rigid set of federal regulations and state education laws. Children who do qualify for speech services in the school system may be placed on a waiting list. Furthermore, speech-language pathologists, who provide speech services in the schools, typically have more children on their caseload than recommended. Supplemental therapy, from a independent therapy provider outside of the school system, reduces the time children spend in treatment.

Only when families seek (ask) supplemental services from their health plan, do they discover that the majority of health plans will not pay for services that may also be provided in a school setting. As a result, the child may become a ping-pong ball that bounces between the school and medical systems, and not receiving needed services.

Communication disorders affect an individual’s health and education simultaneously. Therefore, children are best served when providers (speech-language therapists) from both the school and medical systems work collaboratively to identify the best treatment setting for each child. Many times, children attain their best potential by being served in both settings simultaneously.

Now scheduling for East Frisco location! 8751 Collin McKinney Parkway, Suite 603, McKinney, TX 75070
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