Many wonder if insurance covers occupational, physical, and speech therapy services. Most insurance plans cover it, but reimbursement may not always be easy, and not all situations may be qualified for coverage.
Many insurance plans cover an initial evaluation from a speech therapist, at least. Call your health insurance company if you are looking for a speech therapist. Ask if there are local therapists in your area who are covered by your plan. However, you can check with your insurance company for online speech therapy.
Call your insurance company patiently until you reach the right department. If you have an online account with your insurance, you may also check the information online. Remember to tell your child’s pediatrician or doctor if you’re looking into speech therapy.
Insurance may require your doctor’s referral. This may be a written recommendation, like a prescription, for speech therapy.
Your first speech therapist visit will be your first evaluation. The speech therapist will assess your current situation – your strengths and weaknesses, to identify whether speech therapy is needed. The therapist will then make a report including all the details and give it to the insurance company for their review.
Insurance companies will typically look at these few things upon reviewing speech evaluation:
These factors help decide whether your health insurance will cover your ongoing speech therapy sessions.
It can be really frustrating for both you and your speech therapist if insurance denies coverage. While the therapist can provide additional information to support your case, the final decision on reimbursement is up to the insurance company.
Speech therapy coverage depends on your insurance plan. The number of covered visits, copayments, deductibles, and required services can vary. Some plans might also require pre-authorization or a doctor's referral.
Some insurance plans provide better coverage for speech therapy, while others may offer limited or no coverage. It’s important to check with your insurance company to understand your preferred plan. This helps you know what’s covered, what out-of-pocket costs you might have, and if you need to take any extra steps to ensure your care is covered.
Some insurance plans may cover out-of-network speech therapy, but the benefits might be lower than seeing an in-network provider. Other plans may not cover it, meaning you'd be responsible for the full cost.
Before seeing an out-of-network speech therapist, it’s important to check with your insurance company to know your coverage better. You can also contact the therapist’s office to find out if they accept your insurance and your out-of-pocket costs.
If you see an out-of-network provider, keep in mind that you might have to pay a higher copayment or deductible. You may also need to reach a higher out-of-pocket maximum before your insurance starts covering costs.
For some, speech therapy is only an option if insurance covers the cost. But if insurance doesn’t cover it, there are other options to explore. Let’s take a look at a few of them.
You can use your HSA or FSA. If you have a flexible spending account (FSA) or a health savings account (HSA), they may reimburse you for speech therapy services. It’s a good idea to check with your insurance company to confirm.
Covering speech therapy costs on your own can be quite an investment, but it usually pays off. However, these costs can add up pretty quickly. It is also important to note that the prices may vary between providers, so it is prudent to take the time to compare your options.
Additionally, online speech therapy is worth exploring, as it offers a more budget-friendly alternative to traditional in-person sessions due to reduced overhead expenses.
