Is Speech Therapy Covered by Insurance?

As a speech-language pathologist (SLP), you may be wondering “Is speech therapy covered by insurance?”

In some cases, it is covered, which is why it’s crucial SLPs know how to get insurance to pay for speech therapy.

The people who benefit from speech therapy vary—in condition, background, and need.  But, like other types of therapy, speech therapy can be expensive—and, as such, many clients may be looking to have insurance cover their bill.

Therefore, you may have clients and prospective clients who ask “Is speech therapy covered by insurance?”

In addition to explaining how to get insurance to pay for speech therapy, this article will help you answer new clients’ questions about financing their treatment, like “Is speech pathology covered by insurance?”, “How much is speech therapy with insurance?”, or “What insurance covers speech therapy?”

First off, is speech therapy covered by insurance?

Depending on the specifics of the case, speech therapy may be covered by insurance. . 

If speech therapy is a medical necessity, there is a good chance it will be covered.

 “Speech therapy is often covered by insurance, particularly when prescribed as medically necessary by a healthcare provider,” says John Crist, founder of Prestizia Insurance—a service that compares insurance and employee benefit quotes for customers. .

So, what constitutes a medical necessity for speech therapy? 

“Coverage typically includes rehabilitative services following an injury or surgery, and developmental speech therapy for children with speech delays or disorders,” says Dalton Tigner, insurance agent at Tigner Insurance & Associates, Inc.

While the answer to the question “Is speech therapy covered by insurance?” is yes in medically necessary cases, there are plenty of reasons insurance could opt out of paying for a patient’s treatment.

“Common reasons for denial include lack of a clear medical necessity, absence of a physician’s referral, or therapy aimed at enhancement of skills for non-medical reasons,” says Tigner.

As a speech pathologist, the documentation you submit to the insurance companies can also play a role in whether a client’s coverage is approved or denied—and whether the answer to “Is speech pathology covered by insurance?” is yes or no.

“Insufficient documentation from the healthcare provider can also be a factor,” says Crist.

How much is speech therapy with insurance and without it?

In those cases where speech therapy is covered by insurance the next step is figuring out how much it costs. The total cost of speech therapy, and how much of that cost is covered by insurance, “varies significantly between policies,” says Crist. 

For example, “some plans cover a percentage of the cost after a deductible is met, while others may have a cap on the number of sessions per year,” according to Tigner. 

Example 1

So, what might that look like? Let’s say you have a client and their insurance plan is structured with coinsurance and they need to meet their deductible before they can use their benefits for speech therapy. 

Here’s what that cost breakdown would look like: 

1. If the client’s deductible is $2,000 annually, they will need to spend that amount that year for out-of-pocket health services—by paying your full rate and/or paying for other applicable services.
   
2. Once the client meets the deductible, their benefits for speech therapy will kick in. If the client has a coinsurance rate of 20%, they will pay 20% of your contracted rate with the insurance payer and their insurance will cover the remaining 80% of the rate.

Example 2

Another example is if your client’s insurance doesn’t require them to meet their deductible for speech therapy, but their insurance policy limits sessions covered per year and uses a copay model (a fixed amount as opposed to percentage of the clinician’s contracted rate). 

Here’s an example of this scenario: 

1. A client has a copay of $75 per session for speech therapy, with a maximum allowable number of 10 sessions per year. The client would only pay $75 per session for the first 10, while their insurance pays the remaining balance of the clinician’s contracted rate.
   
2. If the client continues therapy after 10 sessions that year, the client is responsible for covering the cost of the sessions moving forward until their plan renews. 

The same way it requires more specific details to accurately answer the question “is speech therapy covered by insurance?”, the insurance reimbursement amount for a speech therapy session with insurance can substantially vary depending on the policy. 

There’s also no set cost for how much speech therapy costs without insurance. Consequently, prices for speech therapy will vary by area, therapist, and type of therapy. However, sessions can be significantly more expensive for clients who do not have insurance coverage.

“Without insurance, costs can be substantial, potentially ranging into hundreds of dollars per session—depending on the rates of the therapist,” says Crist.

How to get insurance to pay for speech therapy

It’s important for speech therapy to be accessible for everyone who needs it, but without insurance, the costs can be prohibitive for many clients.

Clients often need to seek out ways to get insurance to cover their speech therapy—and, as a speech-language therapist, you’ll want to do everything on your end to ensure their claims are approved.

Here are a couple ways to help clients get insurance coverage for speech therapy:

Research insurance plans

Alas, people can’t change their health insurance plans whenever they want. There are set time windows (like open enrollment) and occasions (such as after a move or marriage) where people with insurance can change or update their policies. But when clients have the opportunity to change their coverage, they should be doing their research—and looking for what insurance covers speech therapy.

Different health insurance carriers offer various types and amounts of coverage for speech therapy. So, if a client knows that they need speech therapy, either currently or in the future, it’s in their best interest to do their research and figure out which carrier—and policy—will give them the coverage that they’re looking for.

Dig deep into their current policy

If a client isn’t in a position to upgrade their insurance, the best thing they can do is deep dive into their current carrier and policy—and determine what benefits they’re eligible for and how to maximize their coverage. They may be pleasantly surprised after educating themselves on their insurance plan.

“Clients should be encouraged to thoroughly understand their insurance policy and communicate any coverage questions to their insurer,” says Crist. 

Prioritize record keeping

Even in cases where you can definitively say yes to a client asking  “Is speech pathology covered by insurance?” there is no guarantee that the claims you file to the health insurance company for that client will be approved. 

Whether a client’s claims are approved will depend, in large part, on the submission and management of the claim—and that’s where speech therapists can help clients get their therapy covered.

Before you see a new client, you should “verify the patient’s insurance benefits and pre-authorize services when required,” says Crist. 

You can do this by calling the insurance payer, checking the insurance’s website, or using an integrated eligibility checking feature in your practice management software for SLPs.

Once you’ve confirmed that the client is eligible for coverage, it’s important to submit the necessary paperwork to get their claim approved.

“Speech therapists should provide detailed treatment plans and progress reports, emphasizing the medical necessity and expected outcomes to support insurance claims,” says Tigner.

It’s also important for clients to keep track of their own records (for example, referrals and other related documentation) and claims—and follow up with the insurance company as necessary.

“Keeping detailed personal records and following up on claims can also be beneficial,” says Crist.

Appeal when necessary

After you’ve already responded yes to a client asking “is speech pathology covered by insurance?,” it can be nerve-racking to get a rejected claim. 

If a client’s claim is rejected by the insurance company—and they’re eligible for coverage—consider appealing the claim.

“Don’t hesitate to appeal a denial if there’s a legitimate need for therapy,” says Crist. “Often, a well-documented appeal can overturn an initial refusal.”

Be sure to supply the insurance company with any information and documentation they need to revisit the claim. Hopefully, this will help to get the claim approved for the client.

Consider working with clients on cash pay options

In situations where clients either don’t have coverage or their claims were denied (even after an appeal), as a speech therapist, you have a few options—including offering cash pay options.

First, set a rate that you’re comfortable with, and then offer that rate to clients who are seeking speech therapy but are unable to get their insurance to cover your services. 

If you’re a private practice owner and can set your own rates, you might consider offering a discounted rate, or a sliding scale, to make speech therapy accessible to clients that may not be able to afford your normal cash pay rate. 

Although it’s completely up to you whether you want to reduce your rate, if you choose to implement a pay-what-you-can (PWYC) or sliding scale model, there are many ways you can do so.  For example, some SLPs set aside a few sliding scale spots within their practice, while others accept sliding scale clients on a case-by-case basis.

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