Steps to Getting Your Speech Therapy Covered
Communication disorders are medical conditions that are covered by many major medical insurance providers. However, there are some medical insurance providers that do not cover communication disorders. The first step is to determine if your insurance provider covers speech-language pathology services. Call your insurance provider and ask them to send you in writing a list of conditions and ailments that are covered.
What to do when your insurance provider does not cover your condition?
If your insurance provider does not cover communication disorders, find as many written materials on your communication disorder(s) condition but make sure the written materials deem your condition medically necessary. Write a letter justifying reasons why they should provide coverage for your specific communication disorder(s). Moreover, attached a written letter from your doctor justifying why your communication disorder condition is deemed medically necessary. Find as many articles as possible that explain and tell how your communication disorder(s) is a medical condition. Locate other insurance companies that provide coverage for your specific communication disorder condition and ask them to send you data on prognosis and recovery time. Visit the Center for Disease Control and Prevention website to locate information on your condition. All of this will build a case to support why your insurance provider should provide coverage for your communication disorder condition. If all else fails, contact a medical lawyer or mediator to have them write a letter on your behalf as to why they should provide coverage for your communication disorder(s) medical condition.
Pay out of pocket until a decision is reached
This process may take weeks or months to come to a decision. In the meantime, if at all possible, pay out of pocket for therapy and keep all receipts. Keep a chronological journal with receipts and progress reports written or attached to the journal. You may be able to obtain reimbursement for payment if a decision is ruled in your favor.
You may also want to locate an advocate familiar with speech-language pathology and it's disorders. Advocates are expertise in certain areas, find one who is knowledgeable about your specific communication disorder condition and consult with him/her the steps you should take.
The American Speech-Language-Hearing Association
There is a wealth of information on the American Speech-Language-Hearing Association's (ASHA) website that may justify your condition as being medically necessary. You may even what to contact someone at ASHA that can direct you to all the contact people you may need to speak to that may help your insurance provider rule in your favor and cover your communication disorder condition. You may also find on ASHA's website a definition of "medically necessary" as it relates to communication disorders. This may help you understand what it is you should look for when choosing articles, advocates, lawyers, and mediators to justify your case for medical coverage through your medical insurance provider.
Author: Cynthia Willis, M.Ed., CCC-SLP has earned the highest credentials needed to practice speech-language pathology in private practice. Cynthia Willis has earned the Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association (ASHA), of which she is a member. Ms. Willis holds a license from North Carolina State Board of Examiners for Speech-Language Pathology and Audiology. She completed her first year of undergraduate studies at Brooklyn College a City University of New York (CUNY); transferred to Fayetteville State University where she earned a Bachelor of Arts (BA) degree in "Speech and Theater" and minored in "Sociology" (studied multiculturalism and sub-cultures). Ms. Willis earned her Master of Education (M.Ed.,) degree from North Carolina Central University where she studied "Communication Disorders".