Health Insurance Qualifications
It is important to review the health insurance benefits information provided by your health plan before you receive services.
Health benefit plans vary widely depending on the benefits and coverage levels of your plan. Sometimes, the benefits information on your health plan can be confusing. Remember, the benefits booklet you receive is merely a summary of benefits and not the actual contract language. You may need to carefully examine the policy itself to truly understand your health plan's coverage and limitations. When in doubt check with your insurance provider to confirm your benefits.
We work with most major insurance plans including Blue Cross/Blue Shield, Cigna, United Healthcare, the Baylor Scott & White Health Plan, and TriCare Insurance in support of our local military families.
Contact us for more details on our insurance plan credentials
Understand Your Benefits
Coverage information for speech services may be included under "physical therapy and other rehabilitation services" or "other medically necessary services or therapies".
Coverage of evaluations and/or assessment are "testing" and treatment is "therapy" services for most speech disorders. Limitations and exclusions are typically located in a separate section, and might be referred to as "Things We Don't Cover" or "Exclusions to Coverage".
Common Limitations and Exclusions
- No coverage for speech or feeding disorders that have a developmental or congenital cause
- Coverage for acquired disorders only or only for treatment that is restorative or rehabilitative
- No coverage for certain disorders, such as stuttering and autism
- A limit on the dollar amount that will be reimbursed for speech and/or hearing services
- A limit on the number of speech or feeding therapy sessions that will be reimbursed
- Coverage may also be limited to certain settings such as a hospital or clinic
- No coverage for devices such as hearing aids or speech-generating devices
When in doubt, check it out!
If you are unsure about the coverage your health plan provides for speech or feeding services, call the 800 number listed on your ID card and speak to a customer service representative. Request that they provide any clarification of your coverage in writing. Remember to keep copies of all documentation, including date, time, and contact person!
Get Permission Before Your Visit
Your health plan may require that you obtain prior approval or that a physician "prescribe" speech or feeding services. This may also be referred to as "pre-authorization", "pre-certification" or "pre-determination". Read on to find out the subtle differences between these three terms.
Pre-authorization
How the health plan verifies your coverage against the proposed care.
Pre-certification
Requires that you notify the health plan before undergoing certain diagnostic or surgical procedures. The health plan assigns an authorization number.
Pre-determination
A health plan requirement in which the provider must request confirmation from the health plan that the service or procedure to be performed is covered under your policy.
Every health plan is different, so you'll need to call the 800 number listed on your ID card and speak to a customer service representative to determine what speech or feeding services need prior approval.
Unfortunately, prior approval does not always guarantee coverage. So, always check with your health plan before having any service performed.
Remember to keep copies of all documentation, including date, time, and contact person!
Questions About Insurance Coverage?
Contact us today and we'll help you understand your benefits