Your child requires speech therapy, now what? You talk to some friends, search some facebook groups, and find the PERFECT therapy practice. You call insurance to find out that Speech Therapy is a covered service, but then after therapy, you receive an invoice for the billed amount? Insurance companies are as different as the individuals that the cover sometimes. When you call your insurance to verify coverage, here are some questions to ask, and what their answers mean.
Is Speech Therapy covered with my plan?
If yes- How many visits are allowed? If given a maximum number, ask if that is a "hard limit" (hard limit means the insurance company does not accept appeals to the limit of sessions. Once that number is exhausted, therapy is no longer covered by insurance and anything that you pay will not go towards your deductible.)
Is (Company name) contracted with my plan? (Is Sprout Therapy? If not, let us know and we can look into contracting with them!)
If Speech Therapy is not covered by your plan, or your provider is not in network, check on your out of network benefits.
What is my deductible? (This is the amount of money that you will need to pay in order to have your insurance start to pay towards services)
What percentage will my insurance pay after my deductible?
Do I have any co-pays or coinsurance amounts due?
Know that whatever company you decide to work with *should* be calling and asking these same questions prior to starting therapy. This is not saying that the company doesn't need to be doing their due diligence; however, it will help you to prepare and know what bills you can expect, even though something is "covered" or "in network" with your plan. Depending on your deductible, sometimes private paying ends up being cheaper than your contracted insurance rate. Ask questions to your provider and find the best payment option to get your child the care that they need!
Please feel free to call, email, or comment below with other questions you may have to better understand how insurance and therapy works.
Lori Kallevig
