Abby Barnes, M.S., CCC-SLP
When it comes to services like speech, occupational, and physical therapy, many people wonder, “Will my insurance cover it?” For many health insurance plans, the answer is yes! But getting reimbursed may not always be so simple, and not every speech therapy situation may qualify for coverage.
Here’s what you need to know about insurance for speech therapy, whether it’s for a toddler, child, teen, or adult. We also provide options to consider if your insurance doesn’t cover speech therapy.
How do you know if your insurance covers speech therapy?
Does insurance cover speech therapy? Many insurance plans will at least cover an initial evaluation from a speech therapist. If you’re looking for a speech therapist, go right to the source and call your health insurance company. Ask if there are speech therapists local to your area that are covered by your health plan. Online speech therapy is an option to ask your insurance company about as well.
To contact your insurance, look on your insurance card and call the customer service phone number. You will likely be asked several questions in order to get to the right department. Tell them you are checking on speech therapy coverage and which providers are in-network with your insurance.
Tell your doctor or your child’s pediatrician that you’re looking into speech therapy.
If you have an online account with your insurance, you may even be able to check this information online.
One thing to keep in mind: It’s a good idea to tell your doctor or your child’s pediatrician that you’re looking into speech therapy. Insurance may even need a referral from your doctor. This is essentially a written recommendation for speech therapy, somewhat like a prescription.
How do you find a speech therapist?
Once you get a list of approved speech therapy providers in your area, start your research! Look up the providers online to learn more about them and read reviews.
It’s important to find a speech therapist who is experienced in your area of concern. Feel free to call different practices to ask about their therapists’ experience. You can also ask when and where they offer appointments and if there is a waitlist to get started.
How do insurance plans decide whether to cover speech therapy?
Your first visit with a speech therapist will be your initial evaluation. At this appointment, the speech therapist will assess your current strengths and weaknesses and determine whether speech therapy is necessary. The speech therapist will then write up a report that includes all this information and send it to the insurance company for review.
When reviewing a speech evaluation, insurance companies typically look at a few things:
The scores on the tests used during the evaluation. Insurance will want to see scores low enough to show a clear need for speech therapy.
The number of sessions, or time in therapy, that the speech therapist recommends. Insurance companies then decide how much of that recommended time they will cover.
The medical necessity of speech therapy. Insurance companies want to see evidence that it’s medically necessary for a person to receive speech therapy. The speech therapist can play an important role here, explaining why they recommend speech therapy and why not receiving therapy may be harmful.
All of these factors determine whether your health insurance will cover ongoing speech therapy sessions.
It can be very frustrating for both the client and the speech therapist if insurance denies coverage. The speech therapist may be able to provide more information to further make the case for coverage, but ultimately it’s up to the insurance company to decide if they will reimburse.
Other options if insurance won’t cover speech therapy
For some people, speech therapy is only possible if insurance is reimbursing the cost. But there are other options to consider when insurance won’t cover speech therapy. Let’s take a look at some of them.
Use your HSA or FSA. Many people wonder if speech therapy is FSA eligible. If you have a flexible spending account (FSA) or a health savings account (HSA), they will likely reimburse for speech therapy services. Again, this is something to ask your insurance company about.
Consider out-of-pocket payment. This is sometimes called “private pay.” It means paying for speech therapy yourself. Although speech therapy is well worth the investment, out-of-pocket costs can get pricey. However, costs can differ from practice to practice, so it’s worth shopping around. This is another reason to look into online speech therapy. Virtual speech therapy often costs less than traditional in-person therapy, which has more overhead costs.
Look into speech therapy services offered at your public school. If you are the parent or caregiver of a child who needs speech therapy, talk to their public school about services. Your child may qualify for speech therapy at school. One thing to note, however, is that school speech therapy is often offered to kids as a group. Your child may not get the same one-on-one attention they would through a speech therapy practice. But group speech therapy is certainly better than no speech therapy at all, and school speech therapists work hard to give all their students the most time and attention possible.
The benefits of private pay for speech therapy
If you do pay out-of-pocket for speech therapy, there are certainly benefits.
For one, your insurance company won’t be the one deciding if you qualify for therapy and how long you can receive it. A licensed, certified speech-language pathologist will determine whether speech therapy is needed and the length of treatment. Many people need speech therapy for reasons that aren’t directly tied to medical necessity. Some children need help in areas of language development that are related to social and academic performance. Some adults want to improve a lisp, grow their public speaking skills, or modify their accent. Insurance may not view these as being medically necessary reasons. But if you’re paying out of pocket, you won’t have to worry about this.
It takes time to talk with your insurance company and research your options. But if you or your child would benefit from speech therapy, the effort is worth it! Everyone deserves the chance to be a clear, confident communicator, and working with a licensed speech therapist will help you get there.
