Your Health Insurance Policy SparkNotes

By Leah Arundel, Clinic Administrator
Duncan Lake Speech Therapy, LLC

Navigating insurance coverage for specialized services can be quite confusing. Here are some helpful tips to help you understand insurance at our private speech therapy office:

Know your plan type!

Different types of health insurance plans have different coverage options for speech therapy services. Some plans may cover private speech therapy, while others may require you to see a therapist within a specific network or limit coverage to certain conditions;

  • In-network: Speech pathologists who are contracted with your insurance provider are considered in-network providers. In-network providers typically have lower copays and coinsurance than out-of-network providers.
  • Out-of-network: Speech pathologists who are not contracted with your insurance provider are considered out-of-network providers. You may still be able to see an out-of-network provider, but you’ll typically have higher copays and coinsurance.

Contact your insurance provider!

Contact your insurance provider in advance to understand your coverage options. They can provide you with more detailed information about your benefits and answer any questions you may have such as:

  • Copay: This is a fixed amount that you pay for each speech therapy session. Copays may vary depending on your insurance plan, and they may apply to in-network and out-of-network providers differently.
  • Deductible: This is the amount you will need to pay out of pocket before your insurance begins to cover your speech therapy sessions. Deductibles can vary depending on your insurance plan and typically reset annually.
  • Coinsurance: This is the percentage of the cost of each speech therapy session that you are responsible for paying after meeting your deductible. Coinsurance can vary depending on your insurance plan.
  • Out-of-pocket maximum: This is the maximum amount you’ll have to pay for speech therapy sessions in a given year. Once you reach your out-of-pocket maximum, your insurance will cover the remaining cost of your therapy sessions.

Inquire about pre-authorization requirements!

Some insurance plans require pre-authorization for speech therapy services. If needed, our office will do our part in obtaining a speech therapy prescription, signed by your PCP, and we will submit it to your insurance company for approval. Failing to obtain pre-authorization can result in denied claims and unexpected expenses.

Understand the billing process!

Because we are a private speech therapy office, we have integrated our own unique billing process. Make sure you understand how your therapy sessions will be billed and what your responsibilities are for paying any outstanding balances by reading our payment policy within our intake process!

Following these few tips will help you better understand your insurance coverage at our office and help you make informed decisions about your treatment. So in all, always remember to contact your insurance provider, ask about out-of-pocket expenses and pre-authorization requirements, understand our billing process, and never hesitate to ask us questions!

Leave a Reply

Your email address will not be published. Required fields are marked *

Scroll to top