Does your insurance cover speech therapy?

The only way to know is to call and ask.  Then write down the information. 

Medicare

Speech Spark Services is in-network with Medicare.  Medicare Part B usually covers 80% of medically necessary skilled speech therapy. We will handle submitting for reimbursement from Medicare.  Often, Medicare will also submit to your secondary insurance for the remaining 20%.  

Private Pay

All non-Medicare clients are considered private pay.  Unlike many other companies in the area, Speech Spark can see clients on a private-pay basis only, or continue private pay after insurance is exhausted.  

Insurance

Many insurance companies do reimburse for out-of-network speech therapy services.  

After you make payment for therapy you will receive a receipt of payment on an invoiced “superbill” that you can turn in to your insurance provider in order to be reimbursed from your insurance directly.  Speech Spark Services, LLC cannot bill any insurance company that we are not in-network with.  We are not responsible for the accuracy of responses you receive when you call.  If necessary and requested, we can provide you will evaluation results, treatment notes requested by the insurance company, but we are not responsible for insurance's coverage/reimbursement determinations.

You will need to call your insurance company to find out:

  • Your coverage

  • How to submit for reimbursement - what needs to be included, where to send it to, any time restrictions.

Before you call, be sure you have your current insurance card in front of you

Write down the date, time of your call, as well as the representative’s name. 

Tell the representative you are calling to check on your benefits and coverage for speech therapy.

Suggested questions:

Coverage

  • Under what circumstances does my policy cover speech therapy?
  • Does my speech therapy have an exclusion clause about covering therapy?
    • If yes, what is it?
  • How many visits are allowed per year of therapy? 
    • Once those visits are used up under what circumstances can I get more visits authorized?
    • Have any visits been used to date?
  • Can I choose a speech therapist outside of our network/provider list?

Pre-Authorization Requirements

  • Is there a requirement that I get a prior authorization and/or a referral before I see a speech therapist?
    • If yes, who do I contact? ____________________       Phone#:______________________________
  • Do I need any Pre-Authorization from my primary care doctor for speech therapy?
    • If yes, What do I need from my doctor? (e.g. prescription)

Reimbursement

  • What is the difference for coverage of out-of-net-work vs in-network?
  • What is the deductible for out-of-network?
    • How much of the deductible has been met?
  • Do I have a co-payment or is there a percentage of the bill I will be responsible for out-of-network speech therapy visits? 
    • How much?
  • Do I have co-insurance?
    • How much?
  • What is my out of pocket maximum?

Submitting Reimbursement

  • What do I need to do in order to submit for reimbursement of speech therapy services?
  • Where do I send the Superbill?

 

If anything is unclear, ask for clarification or speak with a supervisor. This will help avoid surprises after you submit for reimbursement.

Remember that you are responsible for all charges at the time of service.  Your insurance coverage and any reimbursement is a contract between you and your insurance company.  The above is only general recommendations and Speech Spark Services, LLC, is not responsible for coverage.

After you make payment for therapy you will receive a receipt of payment on an invoiced “superbill” that you can turn in to your insurance provider in order to be reimbursed from your insurance directly.  Speech Spark Services, LLC cannot bill any insurance company that we are not "in-network" with.